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Published online: 2024-06-25

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Preoperative embolisation of head and neck paragangliomas — a single-centre experience

Paweł Szmygin1, Maciej Szmygin2, Tomasz Roman2, Andrzej Kucharski3, Tomasz Jargiełło2, Radosław Rola1, Marcin Szymański3

Abstract

Introduction. Paragangliomas are neuroendocrine tumours commonly located in the abdomen, thorax, head and neck. The definitive treatment for these tumours is surgical resection, which in some cases can be very challenging due to the involvement of critical neurovascular structures and their high vascularity. Therefore, pre-operative embolisation may be performed to reduce the risk of complications. This study aimed to present our experience with endovascular embolisation of head and neck paragangliomas (HNP).

Material and methods. In this single-centre study, we reviewed data from consecutive patients with HNP who underwent pre-operative embolisation from 2017 to 2023. The efficacy of embolisation, the method of embolisation, as well as the rate of complications, were noted.

Results. A total of 27 patients (15 females) with an average age of 47 years underwent selective embolisation of HNP. Satisfactory embolisation, defined as occlusion of > 75% of the blood supply, was achieved in 22/27 cases (81.5%). The most commonly used embolic agents included coils and microspheres. With the exception of minor vessel dissections in two patients and embolic agent migration in two patients causing reversible occlusion of the intracranial vessels, there were no other complications associated with embolisation. No neurological deficits occurred in relation to the endovascular procedure.

Conclusions. The results of our study indicate that endovascular embolisation of HNP prior to surgical resection is a safe and efficacious procedure, with a relatively low complication rate and associated morbidity.

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References

  1. Young WF. Paragangliomas: clinical overview. Ann N Y Acad Sci. 2006; 1073: 21–29.
  2. Ikram A, Rehman A. Paraganglioma. StatPearls Publishing;, Treasure Island (FL): 2024.
  3. Neumann HP, Pawlu C, Peczkowska M, et al. European-American Paraganglioma Study Group. Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations. JAMA. 2004; 292(8): 943–951.
  4. Mete O, Asa SL, Gill AJ, et al. Overview of the 2022 WHO Classification of Paragangliomas and Pheochromocytomas. Endocr Pathol. 2022; 33(1): 90–114.
  5. Carrasquillo JA, Chen CC, Jha A, et al. Imaging of Pheochromocytoma and Paraganglioma. J Nucl Med. 2021; 62(8): 1033–1042.
  6. Pellitteri PK, Rinaldo A, Myssiorek D, et al. Paragangliomas of the head and neck. Oral Oncol. 2004; 40(6): 563–575.
  7. Kollert M, Minovi AA, Draf W, et al. Cervical paragangliomas-tumor control and long-term functional results after surgery. Skull Base. 2006; 16(4): 185–191.
  8. Neumann HPH, Young WF, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med. 2019; 381(6): 552–565.
  9. Szymańska A, Szymański M, Czekajska-Chehab E, et al. Diagnosis and management of multiple paragangliomas of the head and neck. Eur Arch Otorhinolaryngol. 2015; 272(8): 1991–1999.
  10. Boedeker CC, Boedeker CC, Boedeker CC, et al. European-American Paraganglioma Study Group. Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations. JAMA. 2004; 292(8): 943–951.
  11. Texakalidis P, Charisis N, Giannopoulos S, et al. Role of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis. World Neurosurg. 2019; 129: 503–513.e2.
  12. De Marini P, Greget M, Boatta E, et al. Safety and technical efficacy of pre-operative embolization of head and neck paragangliomas: A 10-year mono-centric experience and systematic review. Clin Imaging. 2021; 80: 292–299.
  13. Abu-Ghanem S, Yehuda M, Carmel NN, et al. Impact of preoperative embolization on the outcomes of carotid body tumor surgery: A meta-analysis and review of the literature. Head Neck. 2016; 38 Suppl 1: E2386–E2394.
  14. Gupta AK, Purkayastha S, Bodhey NK, et al. Preoperative embolization of hypervascular head and neck tumours. Australas Radiol. 2007; 51(5): 446–452.
  15. Duffis EJ, Gandhi CD, Prestigiacomo CJ, et al. Society for Neurointerventional Surgery. Head, neck, and brain tumor embolization guidelines. J Neurointerv Surg. 2012; 4(4): 251–255.
  16. Schartz D, Manganaro M, Szekeres D, et al. Direct percutaneous puncture versus transarterial embolization for head and neck paragangliomas: A systematic review and meta-analysis. Interv Neuroradiol. 2023 [Epub ahead of print]: 15910199231188859.
  17. Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Intervent Radiol. 2008; 25(3): 204–215.
  18. Zhang J, Fan X, Zhen Y, et al. Impact of preoperative transarterial embolization of carotid body tumor: A single center retrospective cohort experience. Int J Surg. 2018; 54(Pt A): 48–52.
  19. Gözen ED, Tevetoğlu F, Kara S, et al. Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center. Ear Nose Throat J. 2022; 101(4): NP180–NP185.
  20. Brahimaj BC, Beer-Furlan A, Joshi KC, et al. Combined Transarterial and Transvenous Onyx Embolization of Jugular Foramen Paragangliomas. World Neurosurg. 2020; 136: 178–183.
  21. Alexandre AM, Scarcia L, Clarençon F, et al. Preoperative Direct Puncture Embolization Using a Nonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas. Clin Neuroradiol. 2023 [Epub ahead of print].
  22. Kelblová M, Vaníček J, Gál B, et al. Preoperative percutaneous Onyx embolization of carotid body paragangliomas with balloon test occlusion. Front Neurol. 2023; 14: 1132100.
  23. Pedicelli A, Lozupone E, Valente I, et al. Pre-operative direct puncture embolization of head and neck hypervascular tumors using SQUID 12. Interv Neuroradiol. 2020; 26(3): 346–353.
  24. Chaudhary N, Gemmete JJ, Thompson BG, et al. Intracranial endovascular balloon test occlusion-indications, methods, and predictive value. Neurosurg Clin N Am. 2009; 20(3): 369–375.
  25. Paramasivam S, Persky M, Berenstein A. Paraganglioma—Role of preoperative evaluation and endovascular embolization. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2016; 27(1): 7–14.
  26. Yang TH, Ou CH, Yang MS, et al. Preoperative embolization of carotid body tumor by direct percutaneous intratumoral injection of N-butyl cyanoacrylate glue assisted with balloon protection technique. J Chin Med Assoc. 2011; 74(2): 91–94.
  27. Gemmete JJ, Chaudhary N, Pandey A, et al. Usefulness of percutaneously injected ethylene-vinyl alcohol copolymer in conjunction with standard endovascular embolization techniques for preoperative devascularization of hypervascular head and neck tumors: technique, initial experience, and correlation with surgical observations. AJNR Am J Neuroradiol. 2010; 31(5): 961–966.
  28. Krishnamoorthy T, Gupta AK, Rajan JE, et al. Stroke from delayed embolization of polymerized glue following percutaneous direct injection of a carotid body tumor. Korean J Radiol. 2007; 8(3): 249–253.
  29. American Society of Interventional and Therapeutic Neuroradiology. Carotid artery balloon test occlusion. AJNR Am J Neuroradiol. 2001; 22(8 Suppl): S8–S9.