title: Evolving experience with direct puncture therapeutic embolization for adjunctive and palliative management of head and neck hypervascular neoplasms.
abstract: OBJECTIVE
  The use of percutaneous, direct puncture therapeutic embolization (DPTE) of hypervascular head and neck neoplasms is a relatively new modality that may be used to supplement or supplant conventional endovascular transarterial embolization. Although the preliminary clinical experience reported by a single group has been favorable, extensive case series experience is lacking. This prompted us to review our recent clinical experience with these techniques to determine safety, efficacy, and emerging role in the overall neurointerventional therapeutic armamentarium.
  
  
  METHODS
  A retrospective analysis of the previous 34 consecutive cases of hypervascular tumors undergoing DPTE referred to our service for therapeutic devascularization was performed.
  
  
  METHODS
  Complete case record review was undertaken. Twenty-six of 34 cases involved DPTE of head and neck neoplasms. Conventional diagnostic angiography was performed for therapeutic planning and to assist in precise localization. When performed, standard microcatheter transarterial embolization techniques were used either before or after attempted DPTE. Cyanoacrylate embolic mixtures (n-butyl cyanoacrylate [NBCA], lipiodol, powdered tungsten) were used in 21 of 24 cases, and absolute ethanol in 3 of 24. Direct puncture angiography of the targeted tumor neovasculature was always performed before DPTE.
  
  
  RESULTS
  Twenty-four of 26 cases had technically successful DPTE. Combined transarterial embolization with DPTE was used in 16 of 24 cases, although for the last 12 cases, 9 were treated predominantly or exclusively by DPTE. There were no major or minor clinical complications, and there was one asymptomatic technical complication. Total or near-total devascularization was achieved in all cases. All preoperative cases had excellent hemostasis within the resected tumor bed.
  
  
  CONCLUSIONS
  Our results lend further support to the safety and efficacy of DPTE in the management of hypervascular neoplasms of the head and neck. With our increasing experience, this technique is evolving into a primary therapeutic modality for optimal tumor devascularization.
authors.affiliation: Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242-1077, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Chaloupka
authors.forename: S
authors.initials: S
authors.lastname: Mangla
authors.forename: D C
authors.initials: DC
authors.lastname: Huddle
authors.forename: T C
authors.initials: TC
authors.lastname: Roth
authors.forename: S
authors.initials: S
authors.lastname: Mitra
authors.forename: D A
authors.initials: DA
authors.lastname: Ross
authors.forename: C T
authors.initials: CT
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D002015:Bucrylate / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000098:blood supply / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000098:blood supply* / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000098:blood supply / Q000628:therapy; D010166:Palliative Care; D010235:Paraganglioma / Q000098:blood supply / Q000628:therapy; D010610:Pharyngeal Neoplasms / Q000098:blood supply / Q000628:therapy; D011677:Punctures; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives; D002015:Bucrylate