title: The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  There is no definitive consensus on the impact of preoperative embolization on carotid body paraganglioma management. The purpose of this study was to assess the effects of preoperative embolization on carotid body paraganglioma excision.
  
  
  METHODS
  A systematic search was conducted without limits, and it included studies published on or before July 2013 from PubMed, CINAHL, Web of Knowledge, and the Cochrane Library. Relevant synonyms for the search terms "paraganglioma,""carotid body tumor," and "embolization" were applied.
  
  
  METHODS
  Studies evaluating patients undergoing surgical intervention with embolization for carotid body tumors were included. Two reviewers independently assessed the titles and abstracts for inclusion and extracted the data. The guidelines set forth by the Cochrane Collaboration were followed in the process of data extraction. Data were pooled with a fixed effects model, and standardized mean difference (SMD) and 95% confidence intervals (95% CIs) are reported.
  
  
  RESULTS
  A total of 22 studies (15 nonrandomized studies with a comparator, 7 single-arm studies) were included, enrolling 578 patients with 607 tumors. Patients undergoing preoperative embolization had significantly less estimated blood loss compared with those of surgical excision only (12 studies; 295 tumors; SMD: -0.52; 95% CI: -0.77, -0.28). Patients undergoing preoperative embolization had less operative time compared with that of surgical excision only (6 studies; 174 tumors; SMD: -0.46; 95% CI: -0.77, -0.14).
  
  
  CONCLUSIONS
  Surgical excision with preoperative embolization appears to decrease estimated blood loss and operative time when compared with that without preoperative embolization for carotid body paragangliomas.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA ryanjackson.md@gmail.com.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Jackson
authors.affiliation: Department of Otolaryngology, NEA Baptist Clinic, Jonesboro, Arkansas, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Myhill
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Tapan A
authors.initials: TA
authors.lastname: Padhya
authors.affiliation: Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Judith C
authors.initials: JC
authors.lastname: McCaffrey
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: McCaffrey
authors.affiliation: Division of Evidence-Based Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA.
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Mhaskar
mesh_terms: D002345:Carotid Body Tumor / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D006801:Humans; D019106:Postoperative Hemorrhage; D011300:Preoperative Care
keywords: carotid body tumor; embolization; head and neck surgery; paraganglioma; systematic review