title: Preoperative onyx embolization of vascular head and neck tumors by direct puncture.
abstract: OBJECTIVE
  Preoperative embolization of hypervascular head and neck tumors is frequently performed to reduce operative times and blood loss. While traditional transarterial embolization is commonly used, direct tumoral puncture has also been advocated as an alternative. We report our series of head and neck tumors embolized with onyx via direct tumoral puncture to ascertain the safety and efficacy of embolization using this technique.
  
  
  METHODS
  We prospectively collected data on all head and neck tumors embolized with onyx at our institution during a 24-month period.
  
  
  RESULTS
  A total of 18 patients underwent preoperative embolization via direct tumoral puncture. Tumors included nine carotid body tumors, three glomus vagale tumors, five juvenile nasopharyngeal angiofibromas (JNAs), and one intracranial frontal parasagittal meningioma. All embolizations were completed in a single session. Mean fluoroscopy time was 40 minutes. The overall mean percent tumor devascularization was 87%. Inadvertent transtumoral migration of onyx into the superior sagittal sinus occurred during intraoperative embolization of the meningioma using single-plane fluoroscopy and resulted in a large postoperative hemorrhagic venous infarct. There were no other endovascular-related complications in the remaining patients embolized using biplanar fluoroscopy.
  
  
  CONCLUSIONS
  Embolization of hypervascular head and neck tumors with onyx via direct tumoral puncture can be performed safely and efficiently. Tumor embolization by direct puncture may theoretically lower the risk of inadvertent migration of onyx through nontarget arterial vessels, but may increase the risk of inadvertent transtumoral embolization of venous structures. Caution should be exercised when using this technique for intracranial pathologies, and the importance of biplanar fluoroscopy to allow better visualization of the onyx migration cannot be overemphasized.
authors.affiliation: Department of Neurological Surgery, University of Miami MILLER School of Medicine, Miami, Florida, USA. melhammady2@med.miami.edu
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.forename: Eric C
authors.initials: EC
authors.lastname: Peterson
authors.forename: Jeremiah N
authors.initials: JN
authors.lastname: Johnson
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000792:Angiography; D002533:Cerebral Angiography; D002648:Child; D003625:Data Collection; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011145:Polyvinyls / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D011446:Prospective Studies; D013129:Spinal Puncture / Q000379:methods; D019043:Vascular Neoplasms / Q000601:surgery*; D055815:Young Adult
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer