Facial Nerve Paralysis after Onyx Embolization of a Jugular Paraganglioma: A Case Report with a Long-Term Follow Up

Odat, Haitham; Alawneh, Khaled; Al‐Qudah, Mohannad

doi:10.3390/jcm7030048

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…While embolization with tumor penetration has been shown to have a higher cranial nerve risk profile, PVA embolization in this series demonstrates an efficient technique with reduced risk. 8,10,13,14 Over the years a number of embolization materials have become available including, ethyl vinyl alcohol, cyanoacrylate, coils, and particles. When considering embolization of jugular paraganglioma tumors, it is important to realize the close proximity of the vasa vasorum of cranial nerves and the risk of cranial neuropathies.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective

Helal

Vakharia

Brinjikji³

et al. 2021

Interv Neuroradiol

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Background Jugular paragangliomas represent a surgical challenge due to their vascularity and proximity to vital neurovascular structures. Preoperative embolization aids in reducing intraoperative blood loss, transfusion requirements, and improves surgical visualization. Several embolization agents have been used. Objective The aim of this study is to evaluate the safety and efficacy of PVA in pre-operative embolization of jugular paragangliomas. Methods A retrospective review of all patients who underwent jugular paraganglioma resection with pre-operative embolization between 2000 and 2020 was performed. Pre-operative data including baseline patient and tumor characteristics were documented. Outcomes of preoperative embolization including extent of devascularization and post-embolization complications were recorded. Early and long-term postoperative outcomes were reported. Results Twenty-nine patients met study criteria with a median age of 38 years. Average tumor size was 3.4±1.8 cm. The most commonly encountered arterial feeder was the ascending pharyngeal artery followed by the posterior auricular artery. More than 50% reduction in tumor blush was achieved in 25 patients (86.2%). None of the patients experienced new or worsening cranial neuropathy following embolization. Gross total or Near total resection was achieved in 13 patients (44.8%). A STR or NTR was chosen in these patients to preserve cranial nerve function or large vessel integrity. Average intraoperative estimated blood loss was 888 ml, 9 patients (31%) required intra-operative transfusion of blood products. Extent of resection and post-operative complications did not correlate with extent of devascularization. Conclusion Pre-operative embolization of jugular paraganglioma tumors with PVA particles is an effective strategy with a high safety profile.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective

Helal

Vakharia

Brinjikji³

et al. 2021

Interv Neuroradiol

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“…Additionally, there are also several reports in the literature that describe the occurrence of cranial nerve deficits following glomus jugulare embolization due to the close association of tumor arterial supply with the vasa nervosa of cranial nerves [ 3 , 4 , 7 , 13 ]. The incidence of these cranial neuropathy complications is not well described and rates from several small retrospective studies vary greatly: 2-18% [ 4 , 14 , 16 , 23 ]. We did not observe any such complications in this small case series using polyvinyl alcohol particles.…”

Section: Discussionmentioning

confidence: 99%

Jugular foramen paragangliomas: preoperative transcatheter particle embolization

Ishak¹,

Danda

2020

J Cerebrovasc Endovasc Neurosurg

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Jugular foramen paragangliomas (JFP) are benign tumors of neural crest origin that are located along the temporal bone in the region of the jugular bulb and middle ear. The optimal management of these lesions includes surgical excision with or without preoperative embolization as well as stereotactic radiotherapy. The use of preoperative embolization in the treatment of JFP has shown great promise to bridge patients to surgery by diminishing complication rates and decreasing intraoperative bleeding. We present three successful polyvinyl alcohol (PVA) particle embolizations of patients presenting with symptomatic JFPs. All patients recovered completely in the short term with no bleeding during or after resection of paragangliomas and they were discharged free of their presenting symptoms. Early clinical and imaging diagnosis followed by adequate treatment including preoperative transcatheter particle embolization and surgical or radiosurgical interventions can lead to excellent outcomes.

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“…Methods for preoperative embolization of the tumor have been discussed, using different agents, such as cyanoacrylate glue (NBCA), polyvinyl alcohol (PVA), and ethylene vinyl alcohol (onyx) [ 63 ]. According to recent studies, polyvinyl alcohol seems to be the best option for embolization, in comparison with onyx, which proved to give multiple complications, most frequent being cranial neuropathies, due to common vascularization between jugular paraganglioma and facial nerve [ 64 , 65 ]. It should always be kept in mind that tumors that develop near the jugular foramen tend to create a plug-like phenomenon that might lead to venous hypertension; therefore, the embolization of the inferior petrosal sinus seemed to be of great aid when operating these types of tumors [ 63 ].…”

Section: Treatment Optionsmentioning

confidence: 99%

Paragangliomas of the Head and Neck: A Review of the Latest Diagnostic and Treatment Methods

Palade,

Hainarosie,

Zamfir

et al. 2024

Medicina

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Background and objectives: Paragangliomas of the head and neck are rare, slow-growing neuroendocrine tumors, benign in their vast majority, but with a possibility of developing distant metastases. They show great inheritable character, and their behavior has proven to be unpredictable; therefore, they are considered malignant. Material and methods: This article aims to offer a more comprehensive presentation of the pathogenesis, epidemiology, diagnostic methods, imaging development, and treatment guidelines. We tried to bring together all the necessary data that, in our opinion, a head and neck practitioner should know when managing this type of tumor. Our main focus is on the most recent studies, with the purpose of a homogenous presentation of all current guidelines and approaches to this pathology. Results: Paragangliomas of the head and neck are still a disputed topic. One of the main reasons for that is their low incidence of 0.3 to 1 per 100.000 every year. The most frequent locations are the carotid body, the temporal bone, the jugular and mastoid foramen, and the vagal nerve. Their clinical presentation usually involves a painless lateral mass associated with symptoms such as hoarseness, hearing loss, tinnitus, and cranial nerve deficits. Up to 40% of them are inherited, mostly linked with mutations of succinate dehydrogenase complex. Imaging evaluation consists of CT and MRI, and new functional explorations such as 18F-FDA and 18F-FDG PET/CT, 18F-DOPA PET, 123I-MIBG, and 68Ga-DOTATE PET/CT. Measuring the catecholamine levels in the plasma and urine is mandatory, even though paragangliomas of the head and neck rarely display secretory behavior. Treatment mainly consists of surgery, with different approaches and techniques, but conservative management methods such as wait and scan, radiotherapy, proton therapy, and chemotherapy have proven their efficiency. The therapeutical decision lacks consensus, and current studies tend to recommend an individualized approach. Guidelines regarding long-term follow-up are still a matter of debate.

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Facial Nerve Paralysis after Onyx Embolization of a Jugular Paraganglioma: A Case Report with a Long-Term Follow Up

Cited by 7 publications

References 11 publications

Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective

Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective

Jugular foramen paragangliomas: preoperative transcatheter particle embolization

Paragangliomas of the Head and Neck: A Review of the Latest Diagnostic and Treatment Methods

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