Preoperative embolization of carotid body tumor by direct percutaneous intratumoral injection of N-butyl cyanoacrylate glue assisted with balloon protection technique

Abstract

Substantial intraoperative bleeding during surgical removal of carotid body tumor may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial access has proved effective but is often limited by complex vascular anatomy and small feeding vessels that is difficult to catheterize. We report two cases of carotid body tumor treated with direct puncture and intratumoral injection of N-butyl cyanoacrylate glue (NBCA) assisted with balloon protection technique for preoperative devascularization. The result was impressive and minimal bleeding loss during surgery was observed.

Carotid Body Tumor: Experience from a Tertiary Care Hospital

“…Surgical excision with subadventitial dissection is deemed to be enough for Shamblin I and II tumors, however for Shamblin III a more planned approach is needed as it requires resection and repair of vascular segment and clamping/ shunts to control massive intra-operative blood loss [3]. Two of our patients underwent pre-operative angio-embolization since, studies have shown that this technique decreases intra-operative blood loss and simplifies the anatomy by shrinking the tumor size, though it does not help in reducing the rate of cranial nerve injuries [17][18][19][20][21]. Even with sophisticated surgical excision, there is still high percentage of nerve injuries, pseudo-aneurym formation [22,23] and tumor recurrences on long term follow-up [24], though we observed no post-operative complications and recurrences in our study group.…”

Compliant neurovascular balloon catheters may not be compatible with liquid embolic materials: intraprocedural rupture of the protecting balloon during tumor embolization using n-butyl cyanoacrylate and lipiodol mixture

“…Interestingly, several reports of the successful combination of balloon catheters and glue have been published 1 6. Andreou et al ,1 using a Hyperform balloon catheter, reported successful transarterial, balloon-assisted glue embolization of high-flow arteriovenous fistulas.…”

“…Andreou et al ,1 using a Hyperform balloon catheter, reported successful transarterial, balloon-assisted glue embolization of high-flow arteriovenous fistulas. Yang et al 6 reported successful preoperative embolization of carotid body tumor by direct percutaneous injection of glue using distal ICA balloon (Magic B2, Balt, Montmorency, France) protection. We believe that their procedures could be done without any problem because the balloon catheters were positioned remotely from the embolization site and without direct contact with the Lipiodol.…”

Intraoperative embolization with poloxamer 407 during surgical resection of a carotid body tumor

“…7,8 Nevertheless, there are potential risks of acute displacement of glue into brain-supplying arteries during injection, and even delayed migration has been described, 8 so a balloon-protection technique has been described. 9 Scanlon et al, 10 in 2008, described three cases of CBTs treated by interrupting vascular supply via covered stent placement in the ECA with a follow-up range from 23 to 36 months with neither strokes nor deaths but with some mild cranial nerve dysfunction postoperatively.…”