Arterial embolization with Onyx of head and neck paragangliomas.
OBJECTIVE
To report the morbidity and long term results in the treatment of paragangliomas by transarterial embolization with ethylene vinyl alcohol (Onyx), either as preoperative or palliative treatment.


METHODS
Between September 2005 and 2012, 18 jugulotympanic, 7 vagal, and 4 carotid body paragangliomas (CBPs) underwent Onyx embolization, accordingly to our head and neck multidisciplinary team's decision. CBPs were embolized preoperatively. Jugulotympanic and vagal paragangliomas underwent surgery when feasible, otherwise palliative embolization was carried out alone, or in combination with radiotherapy or tympanic surgery in the case of skull base or tympanic extension. Treatment results, and clinical and MRI follow-up data were recorded.


RESULTS
In all cases, devascularization of at least 60% of the initial tumor blush was obtained; 6 patients underwent two embolizations. Post-embolization, 8 patients presented with cranial nerve palsy, with partial or complete regression at follow-up (mean 31 months, range 3-86 months), except for 2 vagal and 1 hypoglossal palsy. 10 patients were embolized preoperatively; 70% were cured after surgery and 30% showed residual tumor. 19 patients received palliative embolization, of whom 5 underwent radiotherapy and 3 received tympanic surgery post-embolization. Long term follow-up of palliative embolization resulted in tumor volume stability (75%) or extension in intracranial or tympanic compartments. Onyx embolization of CBPs resulted in more difficult surgical dissection in 2 of 4 cases.


CONCLUSIONS
Onyx embolization is a valuable alternative to surgery in the treatment of jugulotympanic and vagal paragangliomas; tympanic surgery or radiosurgery of the skull base should be considered in selected cases. Preoperative Onyx embolization of CBPs is not recommended.
Dipartimento di Radiologia diagnostica e Interventistica, Scuola di Specialità di Radiodiagnostica, Università degli Studi di Milano, Ospedale Sanpaolo, Milano, Italy Neuroradiology Department, University Hospital of Purpan, Toulouse, France.
Caterina
http://orcid.org/0000-0001-6339-448X
C
Michelozzi
Neuroradiology Department, University Hospital of Purpan, Toulouse, France.
Anne Christine
AC
Januel
DISIM, Neuroradiology Division, University Hospitals of Geneva, Geneva, Switzerland.
Victor
V
Cuvinciuc
Neuroradiology Department, University Hospital of Purpan, Toulouse, France.
Philippe
P
Tall
Neuroradiology Department, University Hospital of Purpan, Toulouse, France.
Fabrice
F
Bonneville
Department of Otology-Neuro-otology and Skull Base Surgery, University Hospital of Purpan, Toulouse, France.
Bernard
B
Fraysse
Department of Otology-Neuro-otology and Skull Base Surgery, University Hospital of Purpan, Toulouse, France.
Olivier
O
Deguine
Department of ENT, University Hospital of Rangueil-Larrey, Toulouse, France.
Elie
E
Serrano
Neuroradiology Department, University Hospital of Purpan, Toulouse, France.
Christophe
C
Cognard
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage* / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010236:Paraganglioma, Extra-Adrenal / Q000601:surgery / Q000628:therapy*; D011145:Polyvinyls / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
D001672:Biocompatible Materials; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
Angiography; Intervention; Liquid Embolic Material; Neck; Tumor