title: Intraoperative monitoring of intraarterial paraganglioma embolization by indocyaningreen fluorescence angiography.
abstract: Preoperative arterial embolization (AE) of paraganglioma (PG) is widely used to diminish intraoperative blood loss. Thereby conditions for a resection of the tumor shall be improved and risks for facial, vagal or hypoglossus nerve injuries are reduced. The vascularization of jugular and tympanic PGs is particularly complex due to collaterals with the vertebral and internal carotid arteries. Thus AE is often not complete and intraoperative blood loss may still be considerable. The postinterventional perfusion is of interest for the surgeon. We evaluated the arterial perfusion after AE using indocyaningreen (ICG) angiography. Six patients with PG, two carotid PGs, two jugular PGs, one vagal PG and one tympanic PG underwent surgery 1 day after AE. After tumor was exposed, ICG was intravenously applied followed by fluorescence angiography. Residual perfusion was assessed on the video clip and the perfusion index was automatically calculated by the IC-CALC software. This index was compared with the radiologist's assessment of arteriographic control after AE. Two of the six patients showed only marginal residual perfusion. These were patients with carotid PGs. The patient with the vagal PG showed 20%, the patients with jugular PGs 80 and 60% and the patient with the tympanic PG had 70% residual blood flow. The preoperative AE is rarely complete in PGs of the petrous bone. Intraoperative fluorescence angiography is a reliable procedure to evaluate the efficiency of preoperative embolization and can help the surgeon to estimate intraoperative bleeding favouring risks.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany. vanessa.siedek@med.uni-muenchen.de
authors.forename: Vanessa
authors.initials: V
authors.lastname: Siedek
authors.forename: T
authors.initials: T
authors.lastname: Waggershauser
authors.forename: A
authors.initials: A
authors.lastname: Berghaus
authors.forename: C
authors.initials: C
authors.lastname: Matthias
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D002345:Carotid Body Tumor / Q000098:blood supply / Q000601:surgery; D004396:Coloring Agents; D003390:Cranial Nerve Neoplasms / Q000098:blood supply / Q000601:surgery; D004621:Embolization, Therapeutic; D005451:Fluorescein Angiography; D005925:Glomus Jugulare Tumor / Q000098:blood supply / Q000601:surgery; D043485:Glomus Tympanicum / Q000098:blood supply / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D007208:Indocyanine Green; D016343:Monitoring, Intraoperative; D010236:Paraganglioma, Extra-Adrenal / Q000098:blood supply* / Q000601:surgery*; D020421:Vagus Nerve Diseases / Q000601:surgery
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green