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Michel S, Ludovichetti R, Bertalan G, Thurner P, Madjidyar J, Schubert T, Däppen MB, Nölting S, Huber A, Kulcsar Z. Endovascular Embolization as a Stand-Alone Treatment of Head and Neck Paragangliomas with Long-Term Tumor Control. AJNR Am J Neuroradiol 2024:ajnr.A8328. [PMID: 38719606 DOI: 10.3174/ajnr.a8328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/30/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND AND PURPOSE The impact of therapeutic embolization as a stand-alone treatment of head and neck paragangliomas considered surgically high-risk remains insufficiently understood. The aim of this study was to investigate the procedural risks and long-term volumetric development in head and neck paragangliomas with high surgical risk following therapeutic endovascular embolization as a stand-alone treatment. MATERIALS AND METHODS A retrospective database review of patients who underwent endovascular embolization as primary treatment for head and neck paragangliomas lacking appropriate curative treatment options at our institution (from January 2000 to February 2023) was conducted. Tumor volumetric analyses were performed before embolization and during follow-up. To assess the changes in tumor volume over time, the measurements were performed after embolization, first at 6 months and then on a yearly basis up to 6 years (mean follow-up time was 33.7 ± 24.4 months). Subgroup analyses were conducted for vagal and jugular/jugulotympanic paragangliomas. RESULTS A total of 32 head and neck paragangliomas in 28 patients (mean age, 56.1 years ± 16.5 [standard deviation]; 18 female) with therapeutic embolization as stand-alone treatment were evaluated, of which 11 were vagal paragangliomas, 15 jugular/jugulotympanic paragangliomas, and 6 carotid body tumors. After a mean follow-up duration of 33.7 ± 24.4 months, tumor control was achieved in 75%, with significant median tumor volume reduction at 6 months (P = .02, n = 21). Vagal paragangliomas responded the most to embolization with a significantly decreased median volume from 22.32 cm3 to 19.09 cm3 (P = .008, n = 8). Transient complications occurred in 3.4%. CONCLUSIONS Therapeutic embolization as a stand-alone treatment offers a low-risk control of tumor growth in surgically high-risk lesions, with a significant reduction in tumor volume after treatment. Among the different subtypes, vagal paragangliomas exhibited the strongest and longest regression of the tumor volume.
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Affiliation(s)
- Samira Michel
- From the Faculty of Medicine (S.M.), University of Zurich, Zurich, Switzerland
| | - Riccardo Ludovichetti
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Gergely Bertalan
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Jawid Madjidyar
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Martina Broglie Däppen
- Department of Otorhinolaryngology, Head and Neck Surgery (M.B.D., A.H.), University Hospital of Zurich, Zurich, Switzerland
| | - Svenja Nölting
- Department of Endocrinology, Diabetology and Clinical Nutrition (S.N.), University Hospital of Zurich, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, Head and Neck Surgery (M.B.D., A.H.), University Hospital of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
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Batista S, Palavani LB, Fim Andreão F, de Barros Oliveira L, Viviani de Abreu L, Pinheiro AC, Fontoura J, Yuri Ferreira M, Bertani R, Junior de Andrade E, Almeida Filho JA, Paiva WS. Assessing the safety and efficacy of EVOH Pre-Embolization in head and neck paraganglioma tumors: A comprehensive analysis of current literature. J Clin Neurosci 2024; 120:147-153. [PMID: 38244529 DOI: 10.1016/j.jocn.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Head and Neck Paragangliomas are characterized by having a rich blood supply. Presurgical embolization with Onyx as a neoadjuvant treatment is not a consensus regarding its efficacy and safety. Our study aimed to answer this matter through a single-arm meta-analysis. METHODS We systematically reviewed 4 databases. Sixteen studies were described and suitable papers were selected for meta-analysis of estimated intraoperative blood loss (EBL), percentage of tumor devascularization, and complications associated with embolization. RESULTS The study identified 198 patients with 203 tumors, aged between 8 and 70 years. Commonly reported symptoms included neck mass perception and cranial nerve impairment. Carotid Body Tumors were most prevalent (127, 62.5 %), followed by jugular (48, 23.6 %), or vagal (29, 14.2 %) tumors. Eight studies reported estimated intraoperative blood loss (EBL) averaging 261.89 ml (95 %CI: 128.96 to 394.81 ml). In an analysis of 9 studies, 99 % (95 %CI: 96 to 100 %) achieved 70 % or more devascularization, and 79 % (95 %CI: 58 to 100 %) achieved 90 % or more devascularization. Complications from endovascular procedures were observed in 3 % (95 %CI: 0 to 8 %) of 96 patients across 10 studies, including 4 facial nerve deficits. Eighteen postoperative neurological deficits were reported across 15 articles. CONCLUSION Despite acknowledged limitations, with refined indications, EVOH, especially Onyx embolization may significantly bolster patient safety, decreasing EBL and easing surgical resection. Further research with larger studies will refine criteria, optimize techniques, and improve patient care and treatment outcomes in the management of head and neck paragangliomas.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Agostinho C Pinheiro
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Júlia Fontoura
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
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Huang X, Wang L, Chen Y, Liu J, Liu Y, Yang L. The Comparative Outcomes of Particulate Versus Coil Preoperative Embolization for Carotid Body Tumors. Front Oncol 2022; 12:860788. [PMID: 35692768 PMCID: PMC9174660 DOI: 10.3389/fonc.2022.860788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Till now, the effect of different embolic materials (particulate vs coil) on pre-embolization of carotid body tumors remains poorly understood. The aim of this study was to explore the comparative results between particulate and coil embolization for carotid body tumors. Thirty-seven patients with carotid body tumors who underwent embolization before surgical resection were reviewed and analyzed in this retrospective study between 2008 and 2020. Twenty-one patients were included in the particulate group, while 16 patients were included in the coil group. All procedure-related details, complications and 5-year follow-up data were collected in the study. The preoperative embolization time was obviously longer in the particulate group than in the coil group (42.6 ± 12.3 min vs. 33.7 ± 10.1 min, P =.02), and the fluo time of the procedure (864.5 ± 240.9 s vs. 729.6 ± 251.5 s) and cumulative air kerma (634.6 ± 188.4 mGy vs. 486.7 ± 164.7 mGy) value were higher in the particulate group (P =.01). The incidences of total adverse events in both groups were not significantly different (28.6% vs. 25.0%, P >.05); however, two cases of ectopic embolization only occurred in the particulate group. Interestingly, medical expenditure was higher in the particulate group than in the coil group (P =.02). For the 3-year follow-up evaluation, recurrence and all-cause mortality were similar in both groups (P >.05). Preoperative embolization with coils could be relatively safe, have a lower radiation dosage and be cost-effective for the treatment of carotid body tumors.
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Affiliation(s)
- Xun Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Wang
- Department of Critical Care Medicine, Xi’an Traditional Chinese Medicine Hospital, Xi’an, China
| | - Yangjing Chen
- Department of Otolaryngology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jianlin Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yamin Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Lin Yang,
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Liu Y, Jin X, Gao J, Jiang S, Liu L, Lou J, Wang B, Zhang H, Fu Q. Preoperative Alpha-Blocker Therapy in Patients with Missed Preoperative Diagnosis of Extra-Adrenal Retroperitoneal Paraganglioma Undergoing Resection: A Retrospective Study of 167 Cases at a Single Center. Neuroendocrinology 2022; 112:457-466. [PMID: 34004598 DOI: 10.1159/000517196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Preoperative α-adrenergic blockade is thought to decrease perioperative risks and mortality in surgeries for adrenal pheochromocytoma. However, there are limited data on the efficacy of α-blockers in surgeries for retroperitoneal paragangliomas. The aim of this study was to evaluate the effects of the preoperative α-adrenergic blockade on outcomes in patients undergoing surgery for extra-adrenal retroperitoneal paraganglioma. METHODS We searched the clinical database for patients diagnosed with extra-adrenal retroperitoneal paraganglioma by postoperative histopathology in the General Hospital of People's Liberation Army in China from 2000 to 2017. We compared the preoperative status of patients, preoperative examination, preoperative preparation, intraoperative and postoperative cardiovascular events, intake and output, length of stay in the intensive care unit, length of hospital stays, and short-term outcomes between patients who received preoperative treatment with α-adrenergic blockade and those who did not. RESULTS Of the 167 patients enrolled in the study, 61 received preoperative α-adrenergic blockade therapy. Intraoperative heart rate elevation and highest heart rate were higher in patients undergoing tumor manipulation with preoperative α-adrenergic blockade than those who did not (p < 0.05). However, there were no significant differences between these 2 groups in terms of intraoperative blood pressure elevation and systolic blood pressure decrease following tumorectomy (p > 0.05). Moreover, there were no significant differences in postoperative complications and outcomes (p > 0.05). CONCLUSION Under the current medical practice, resection of extra-adrenal retroperitoneal paraganglioma can be successfully carried out with or without preoperative α-adrenergic blockade.
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Affiliation(s)
- Yi Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Anesthesiology, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinye Jin
- Department of Endocrinology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Jie Gao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shan Jiang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lei Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jingsheng Lou
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bo Wang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Anesthesiology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Hong Zhang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qiang Fu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Graham NJ, Smith JD, Else T, Basura GJ. Paragangliomas of the head and neck: a contemporary review. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:R153-R162. [PMID: 37435464 PMCID: PMC10259325 DOI: 10.1530/eo-22-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 07/13/2023]
Abstract
Head and neck paragangliomas (HNPGLs) are slow-growing, vascular, typically benign tumors whose growth may induce significant lower cranial nerve deficits. While most tumors arise sporadically, a significant portion is associated with defined genetic syndromes. While surgical resection has historically been the gold standard, management strategies have evolved with acknowledgement of high surgical morbidity, slow tumor growth rates, and technological advances. Conservative management approaches via observation and newer radiation therapy techniques have become more common. This review seeks to provide an update on contemporary management strategies for HNPGLs and future directions.
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Affiliation(s)
- Nathan J Graham
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gregory J Basura
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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De Marini P, Greget M, Boatta E, Jahn C, Enescu I, Garnon J, Dalili D, Cazzato RL, Gangi A. 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. [PMID: 34467873 DOI: 10.1016/j.clinimag.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/26/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To retrospectively evaluate the safety and technical success of pre-operative embolization (POE) of head and neck paragangliomas (HNP) in a single-center cohort over a 10-year period, and to benchmark our results with those derived from a systematic analysis of the available literature. METHODS All consecutive HNP embolized between November 2010 and April 2020 were included and reviewed. In total, there were 27 HNP in 27 patients [8 (30%) males; 19 (70%) females; mean age 53 ± 16 years; range 30-86]. Embolization technique, total procedure time, dose area product (DAP), complications, rate of HNP devascularization, and technical success (i.e. ≥80% devascularization of the HNP) were recorded and analyzed. A systematic analysis on the safety and technical success of POE was then conducted according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Twenty-one (21/27; 78%) HNP were treated with an endovascular approach and 6/27 (22%) with a percutaneous or combined (endovascular/percutaneous) technique. Mean total procedure time and DAP were 108 ± 48 min (range 45-235) and 92.5 ± 61.3 Gy·cm2 (range 19.9-276.0), respectively. Two (2/27; 7%) complications (one minor, one major) were observed. Mean HNP devascularization was 88 ± 15% (range 23-100) with technical success achieved in 24/27 (89%) HNP. Literature analysis revealed a pooled rate of complication and technical success of 3.8% (95% CI: 0.5-8.8%) and 79.0% (95% CI: 63.6-91.6%), respectively. CONCLUSIONS POE of HNP is safe and results in extensive devascularization in the majority of treated tumors.
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Affiliation(s)
- Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Michel Greget
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Emanuele Boatta
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Christine Jahn
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Iulian Enescu
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford OX3 7LD, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
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Bellamkonda KS, Chen JF, Tonnessen B, Rahmati R, Nassiri N. Superselective carotid body tumor embolization with platinum-based coils. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:1-5. [PMID: 33665522 PMCID: PMC7902276 DOI: 10.1016/j.jvscit.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022]
Abstract
Resection of Shamblin II and III carotid body tumors can be challenging owing to the potential for significant blood loss. Prophylactic use of liquid embolic agents poses a risk of inflammatory reactions and nontarget embolization. On the other hand, coil embolization has traditionally been limited to cases involving external carotid artery sacrifice. Herein we demonstrate that superselective targeting of tumor-feeding vessels using platinum based, fully detachable packing coils is effective at sustained devascularization of Shamblin II and III carotid body tumors without subsequent inflammation, allowing for a longer interval between embolization and tumor resection, and potentially reducing blood loss without need for ligation or reconstruction of the internal or external carotid artery.
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Affiliation(s)
- Kirthi S Bellamkonda
- Division of Vascular & Endovascular Surgery, Yale School of Medicine, New Haven, Conn
| | - Julia Fayanne Chen
- Division of Vascular & Endovascular Surgery, Yale School of Medicine, New Haven, Conn
| | - Britt Tonnessen
- Division of Vascular & Endovascular Surgery, Yale School of Medicine, New Haven, Conn
| | | | - Naiem Nassiri
- Division of Vascular & Endovascular Surgery, Yale School of Medicine, New Haven, Conn
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Shibao S, Akiyama T, Ozawa H, Tomita T, Ogawa K, Yoshida K. Descending musculospinal branch of the ascending pharyngeal artery as a feeder of carotid body tumors: Angio-architecture and embryological consideration. J Neuroradiol 2018; 47:187-192. [PMID: 30423383 DOI: 10.1016/j.neurad.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/01/2018] [Accepted: 10/13/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Although the ascending pharyngeal artery (APhA) is known as a main feeder of carotid body tumors (CBTs), its detailed architecture and embryological consideration have not been described. The objective of this study was to describe the architecture of a descending feeder of the APhA and to consider its origin embryologically through a review of our CBT embolizations. METHODS We retrospectively analyzed data from patients with CBTs who underwent transarterial embolization or angiographic examination-only between July 2010 and February 2017. The arterial supply of the tumors, the number of feeder pedicles, the mean tumor size, embolization materials, complication of embolization, and extent of tumor removal were assessed. The embryological origin of feeding artery was considered based on the literature. RESULTS Eighteen patients with 20 CBTs underwent preoperative embolization or angiographic examination. The number of feeder pedicles was significantly related to the size of the CBT (P = 0.0002). The main feeding artery was the descending branch of APhA, which was hypertrophied and tortuous (18/20, 90%). Embryologically, this artery originated from the musculospinal branch and is termed the "descending musculospinal branch". CONCLUSION The main feeder of the CBTs was the "descending musculospinal branch" of the APhA and needs special consideration such as dangerous anastomosis for embolization.
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Affiliation(s)
- Shunsuke Shibao
- Department of Neurosurgery, Keio University School of Medicine, 35, Shinano-machi, Shinjuku-ku, Tokyo 1608582, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, 35, Shinano-machi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinano-machi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Toshiki Tomita
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinano-machi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinano-machi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35, Shinano-machi, Shinjuku-ku, Tokyo 1608582, Japan
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Abstract
PURPOSE OF REVIEW Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. RECENT FINDINGS Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. SUMMARY Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up.
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Eskey CJ, Meyers PM, Nguyen TN, Ansari SA, Jayaraman M, McDougall CG, DeMarco JK, Gray WA, Hess DC, Higashida RT, Pandey DK, Peña C, Schumacher HC. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e661-e689. [PMID: 29674324 DOI: 10.1161/cir.0000000000000567] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit. The treatment of cerebral aneurysms has also seen substantial evolution, increasing the number of aneurysms that can be treated successfully with minimally invasive therapy. Endovascular therapies for such other diseases as arteriovenous malformations, dural arteriovenous fistulas, idiopathic intracranial hypertension, venous thrombosis, and neoplasms continue to improve. The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
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Lim KZ, Goldschlager T, Chandra RV. Pre-operative embolization of hypervascular spinal metastasis using percutaneous direct intra-tumoural injection with Onyx under local anesthesia. J Clin Neurosci 2017; 44:306-309. [DOI: 10.1016/j.jocn.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022]
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Venara-Vulpe II, Morisod B, Morand GB, Zerlauth JB, Simon C. [Percutaneous embolization and ultrasound scissors for removal of a carotid body tumor]. HNO 2016; 64:917-921. [PMID: 27858099 DOI: 10.1007/s00106-016-0283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Paragangliomas are highly vascularized usually benign neoplasms originating from the sympathoadrenal and parasympathetic paraganglia of the autonomic nervous system. When resectable, the management of these tumors consists of surgical ablation preceded by transarterial embolization. The aim of this article is to describe a novel treatment strategy combining intralesional percutaneous embolization with dissection using ultrasound scissors. The case of a 74-year-old women presenting with a Shamblin type III carotid body paraganglioma is presented. The combined approach of percutaneous embolization and ultrasound scissors permitted complete resection of the tumor with preservation of both the internal and external carotid artery, without postoperative cranial nerve deficits and with minimal blood loss. Preoperative intralesional embolization with a liquid embolic agent less than 24 h prior to surgical intervention in combination with ultrasound scissors appears to be an excellent strategy for surgical management of carotid body paragangliomas.
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Affiliation(s)
- I I Venara-Vulpe
- Klinik für Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitätsspital Lausanne (CHUV), Bugnon 21, 1006, Lausanne, Schweiz
| | - B Morisod
- Klinik für Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitätsspital Lausanne (CHUV), Bugnon 21, 1006, Lausanne, Schweiz
| | - G B Morand
- Klinik für Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitätsspital Lausanne (CHUV), Bugnon 21, 1006, Lausanne, Schweiz
| | - J-B Zerlauth
- Klinik für diagnostische und interventionelle Radiologie, Universitätsspital Lausanne (CHUV), Lausanne, Schweiz
| | - C Simon
- Klinik für Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitätsspital Lausanne (CHUV), Bugnon 21, 1006, Lausanne, Schweiz.
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Abstract
Paragangliomas of the head and neck are rare vascular skull-base tumors derived from the paraganglionic system with an estimated incidence of 1:30,000 accounting for 3% of all paragangliomas. The most common paraganglioma locations of the head and neck in descending order are the carotid body, jugular, tympanic, and vagal paragangliomas. This article discusses the clinical characterics, normal anatamy, imaging findings and protocols, pathology, staging, and differential diagnosis for paragangliomas of the head and neck.
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Griauzde J, Srinivasan A. Imaging of Vascular Lesions of the Head and Neck. Radiol Clin North Am 2015; 53:197-213. [DOI: 10.1016/j.rcl.2014.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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