Percutaneous Embolization for Cervicofacial Neoplasms and Hemorrhages

Abstract

Objective: To retrospectively assess the effectiveness of percutaneous embolization for curative, preoperative or palliative management of hypervascular neoplasms, vascular malformations and bleedings of the head and neck area. Methods: A retrospective 8-year analysis of outcomes in 85 patients undergoing preoperative embolization for tumors or vascular lesions of the head and neck or embolization for refractory tumor bleeding and epistaxis at our hospitals was performed by reviewing case records. Outcome of the preoperatively embolized patients was defined as successful if intraoperative bleeding was <500 ml and/or postinterventional angiogram showed complete occlusion of all tumor-feeding or bleeding vessels. Results: Complete preoperative tumor embolization was achieved in 83.5% of the patients. Partial embolization was possible in 10.5%. All tumor bleedings refractory to conservative therapy and bleedings from epistaxis showed a successful outcome. Conclusions: In vascular lesions and tumors of the head and neck, preoperative percutaneous embolization improved the surgical outcome, reduced intraoperative blood loss significantly and facilitated tumor resectability. Cervicofacial bleeding resulting from a tumor, vascular malformation or epistaxis can be managed effectively by endovascular techniques.

Endovascular Embolization of Head and Neck Tumors

“…Optimal embolization results in tumor devascularization with no visualization of intra-tumoral opacification while avoiding unintended vessel occlusion. Pre-operative tumor embolization for hypervascular neoplasms results in improved surgical outcome, reduced intraoperative blood loss, and facilitates tumor resection (Zahringer et al, 2005). The following guidelines are suggested as indications for tumor embolization: (1) to control surgically inaccessible arterial feeders, (2) to decrease surgical morbidity by reducing blood loss, (3) to shorten the operative procedure time, (4) to increase the chances of complete surgical resection, (5) to decrease the risk of damage to adjacent normal tissue, (6) to relieve intractable pain, (7) to decrease expected tumor recurrence, and (8) to allow better visualization of the surgical field with decreased overall surgical complication (American Society of Interventional and Therapeutic Neuroradiology, 2001).…”

Embolization in the Head and Neck

“…Multiple retrospective series have documented the safety and efficacy of embolization, although the procedure is primarily palliative given the mortality associated with the severity of underlying disease. [99][100][101][102][103][104] Rupture of the proximal carotid arteries related to malignancy is referred to as carotid blowout syndrome (CBS). Carotid occlusion and stent-graft techniques have both been employed with success, although rebleeding, stroke, carotid thrombosis, and infection have complicated outcomes.…”