title: Devascularization of head and neck paragangliomas by direct percutaneous embolization.
abstract: Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32-82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.
authors.affiliation: Department of Radiology, Baskent Universitesi Tip Fakultesi Hastanesi, Fevzi Cakmak Cd. 10., Sk. No. 45, 06490, Bahcelievler/Ankara, Turkey. umut_ozyer@yahoo.com
authors.forename: Umut
authors.initials: U
authors.lastname: Ozyer
authors.forename: Ali
authors.initials: A
authors.lastname: Harman
authors.forename: Erkan
authors.initials: E
authors.lastname: Yildirim
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Aytekin
authors.forename: Tankut Hakki
authors.initials: TH
authors.lastname: Akay
authors.forename: Fatih
authors.initials: F
authors.lastname: Boyvat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D002345:Carotid Body Tumor / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005925:Glomus Jugulare Tumor / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
chemical_list: D004659:Enbucrilate