Combined preoperative onyx embolization and protective internal carotid artery covered stent placement for treatment of glomus vagale tumor: review of literature and illustrative case.
OBJECTIVE
Surgical resection of complex glomus vagale tumors can be complicated by extensive blood loss and might require surgical sacrifice of an encased internal carotid artery.


METHODS
A young patient presented with mass effect from glomus valage tumor. Computerized  tomography angiography showed an encased internal carotid artery. Cerebral angiography demonstrated a highly vascular tumor. A literature review was performed for endovascular treatment options for neck tumors.


RESULTS
Staged preoperative embolization of feeder arteries via internal  maxillary artery, and thyrocervical trunk with onyx was performed. A covered stent was implanted in the cervical internal carotid artery to the common carotid artery; this resulted in complete devascularization of the tumor with exclusion of external carotid artery from the circulation. This  is followed by surgical resection of the tumor.


CONCLUSIONS
Preoperative embolization with onyx decreased the amount of blood loss intra-operatively. The implantation of a covered stent in the cervical internal carotid artery through the common carotid artery contributed for further  devasculatization of the tumor bed, as well as provided a lumen continuity in case iatrogenic carotid injury is encountered intra-operatively.
Department of Neurosurgery, College of Medicine, Neuropsychiatric Institute, University of Illinois at Chicago, IL, USA. alaraj@uic.edu
Ali
A
Alaraj
Kristen
K
Pytynia
Andrew P
AP
Carlson
P Hari
PH
Krishna
Fady T
FT
Charbel
Sepideh
S
Amin-Hanjani
Victor
V
Aletich
D002343:Carotid Artery, Internal / Q000601:surgery*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005918:Glomus Tumor / Q000628:therapy*; D006801:Humans; D010236:Paraganglioma, Extra-Adrenal / Q000628:therapy*; D011145:Polyvinyls / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods*; D015607:Stents; D055815:Young Adult
C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide