Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol.
OBJECTIVE
To report 3 unique cases of cranial neuropathy after super-selective arterial embolization of jugular foramen vascular tumors with ethylene vinyl alcohol.


METHODS
Clinical capsule report.


METHODS
Three tertiary academic referral hospitals.


METHODS
Three patients who underwent superselective arterial embolization (SSE) of head and neck paragangliomas with ethylene vinyl alcohol are described. One individual was treated with primary SSE, whereas the remaining tumors were treated with preoperative SSE followed by surgical extirpation within 72 hours. All patients were found to have new cranial nerve deficits after SSE.


RESULTS
One patient with isolated complete cranial nerve VII palsy demonstrated partial return of function at 8 months. One individual experienced cranial nerve VII, X, and XII palsies and demonstrated partial recovery of function of the involved facial nerve after 19 months. One subject experienced ipsilateral cranial nerve X and XI palsies after SSE and recovered full function of the spinal accessory nerve within 1 week but failed to demonstrate mobility of the ipsilateral true vocal fold.


CONCLUSIONS
We present the first report documenting facial and lower cranial neuropathies after super-selective embolization of head and neck paragangliomas with EVA. Although it is difficult to draw conclusions from this small number of cases, it is plausible that the use of ethylene vinyl alcohol during SSE may result in a higher risk of permanent cranial neuropathy than the use of other well-established and more temporary agents. Knowledge of the arterial supply to the cranial nerves can help the clinician to choose the embolization agent that will provide maximal occlusion while minimizing the risk of complications.
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin 53792-7375, USA. BGartrell@uwhealth.org
Brian C
BC
Gartrell
Marlan R
MR
Hansen
Bruce J
BJ
Gantz
Michael B
MB
Gluth
Sarah E
SE
Mowry
Beverly L
BL
Aagaard-Kienitz
Mustafa K
MK
Baskaya
Samuel P
SP
Gubbels
D000328:Adult; D000368:Aged; D002345:Carotid Body Tumor / Q000628:therapy*; D003389:Cranial Nerve Diseases / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005925:Glomus Jugulare Tumor / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011145:Polyvinyls / Q000009:adverse effects*
D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer