Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas.
OBJECTIVE
Substantial intraoperative bleeding during surgical removal of head and neck paragangliomas may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial approach has proved beneficial but is often limited by complex vascular anatomy and unfavorable locations. We report our experience with the preoperative devascularization of head and neck paragangliomas by using direct puncture and an intralesional injection of cyanoacrylate.


METHODS
We retrospectively analyzed nine consecutive patients with head and neck paragangliomas who were referred for preoperative devascularization. Three patients were treated for carotid-body tumors; two for vagal lesions; and four, for jugular paragangliomas. Direct puncture of the lesion was performed by using roadmap fluoroscopic guidance. Acrylic glue was injected by using continuous biplane fluoroscopy. All patients underwent postembolization control angiography and immediate postoperative CT scanning.


RESULTS
Angiograms showed that complete devascularization was achieved in all cervical glomus tumors, whereas subtotal devascularization was achieved in jugular paragangliomas. In this latter location, the injection of acrylic glue was limited by the potential risk of reflux into normal brain territory via feeders from the internal carotid or vertebral artery. The tumors were surgically removed and histologically examined. No technical or clinical complications related to the embolization procedure occurred.


CONCLUSIONS
Percutaneous puncture of paragangliomas in the head and neck region and their preoperative devascularization by intralesional injection of acrylic glue is a feasible, safe, and effective technique.
Abud
Daniel Giansante
DG
Department of Interventional Neuroradiology, Foundation Rothschild, Paris, France.
Mounayer
Charbel
C
Benndorf
Goetz
G
Piotin
Michel
M
Spelle
Laurent
L
Moret
Jacques
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001016:Aortic Bodies / Q000098:blood supply; D002344:Carotid Body; D002345:Carotid Body Tumor / Q000098:blood supply / Q000628:therapy; D003131:Combined Modality Therapy; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004621:Embolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005925:Glomus Jugulare Tumor / Q000098:blood supply / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010235:Paraganglioma / Q000098:blood supply / Q000628:therapy*; D010236:Paraganglioma, Extra-Adrenal / Q000098:blood supply / Q000628:therapy; D011677:Punctures; D012189:Retrospective Studies; D016896:Treatment Outcome
D003487:Cyanoacrylates; C421461:glubran 2