Transarterial Embolization of Vascular Tumors in the Head and Neck

Abstract

Preoperative embolization of hypervascular tumors is a standard practice among most developed nations. In this article, the background, technique, benefits, and risks of embolization of the major vascular tumors of the head and neck, primarily paragangliomas, angiofibromas, and meningiomas are reviewed. The evidence for and against embolization is critically examined, and there is an attempt to formulate recommendations based on that evidence.Objectives: On completion of this article, the reader will be able to (1) identify the rationale and describe the technique of transarterial embolization of vascular tumors of the head and neck, and (2) understand the risks and benefits of these procedures. Accreditation: Tufts University School of Medicine (TUSM) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. TUSM takes responsibility for the content, quality, and scientific integrity of this CME activity. Credit: TUSM designates this educational activity for a maximum of 1 Category 1 credit towards the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. PARAGANGLIOMAS BackgroundParagangliomas, more colloquially (and incorrectly) known as glomus tumors, are uncommon to rare tumors of neural crest origin. More than 80% originate in the head and neck region, either along the cervical carotid artery (carotid body and vagal paragangliomas) or in the temporal bone (jugular and tympanic paragangliomas). As with pheochromocytomas, a related tumor of neural crest origin, they have a recognized propensity toward multicentricity and malignancy, and a small percentage exhibit neurosecretory activity. In a series of 46 patients with vagal paragangliomas, multicentric tumors were seen in 17 patients (37%). 1 Multiple tumors are usually