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

Abstract

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.

Intraoperative hybrid technique for excision of temporal bone paraganglioma: A case report

“…Preoperative angiographic embolization is a wellestablished practice in the management of temporal bone paragangliomas and may achieve a mean of 91% devascularization of the lesion. 8 However, it also carries a risk of 18% for the development of permanent cranial neuropathies. 7 Preoperative embolization using Ethylene vinyl alcohol (EVOH) through the ascending pharyngeal artery, the primary feeding vessel, was regarded as excessively hazardous due to the potential for irreparable harm to the lower cranial nerves (IX, X, XI).…”

“…11,13,14 In addition, a notable advantage of the hybrid procedure was its ability to exert a better hemostasis and provide the flexibility for real-time adjustments during surgery. In a study by Helal et al 8 on preoperative angioembolization of jugular paragangliomas, the authors archived a reduction of 50% in 86% of patients, and 31% of patients necessitated intraoperative transfusion of blood products. An underlying rationale for this approach could be the authors' cautious restriction of injections to mitigate the risk of neurological damage.…”

“…4 Given the vascularity of paragangliomas, preoperative angioembolization performed 24-48 h prior to resection stands as a valuable strategy for mitigating intraoperative blood loss and enhancing the precision of surgical excision. [4][5][6][7][8] However, preoperative angioembolization presents several drawbacks. First, it is linked to a relatively elevated incidence of cranial nerve neuropathies, with one study reporting rates as high as 18%.…”

“…Available treatment modalities include observation, external beam radiotherapy, radiosurgery, or surgery 4 . Given the vascularity of paragangliomas, preoperative angioembolization performed 24–48 h prior to resection stands as a valuable strategy for mitigating intraoperative blood loss and enhancing the precision of surgical excision 4–8 . However, preoperative angioembolization presents several drawbacks.…”

Đánh Giá Kết Quả Nút Mạch Tiền Phẫu Các Khối U Tăng Sinh Mạch Của Vùng Đầu Mặt Cổ

“…Bên cạnh các vật liệu nút tắc mạch vĩnh viễn, vật liệu tắc mạch tạm thời (gelfoam) cũng có thể lựa chọn cho các khối u tiền phẫu, nhất là tắc động mạch lớn để giảm chảy máu trong khi phẫu tích. Đặc điểm của gelfoam là sẽ được hấp thụ sau 7 -10 ngày và làm tái thông lòng mạch, vì vậy phẫu thuật sớm sau khi nút mạch nên tiến hành để tận dụng được hiệu quả tắc mạch cao nhất [5].…”