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Mitre LP, Palavani LB, Batista S, Andreão FF, Mitre EI, de Andrade EJ, Rassi MS. Friend or Foe? Preoperative Embolization in Jugular Paraganglioma Surgery-A Systematic Review and Meta-Analysis. World Neurosurg 2024; 190:22-32. [PMID: 38942141 DOI: 10.1016/j.wneu.2024.06.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Jugular paragangliomas are highly vascularized tumors that can grow in challenging neurovascular compartments and are particularly challenging to resect. There is still no consensus whether preoperative embolization should be employed to minimize intraoperative morbidity. METHODS A systematic review and meta-analysis was conducted by searching PubMed, Web of Science, and Embase databases for key terms including "embolization," "jugular paragangliomas," and "surgery." RESULTS This review included 25 studies with 706 patients and 475 (67%) preoperative embolizations. Polyvinyl alcohol particles were the most common embolic agent (97.8% of all patients who underwent embolization). Complication rate of embolization was 1% (95% confidence interval [CI]: 0%, 2%). Preoperative embolization was significantly associated with less intraoperative estimated blood loss (mean difference of -7.92 dL [95% CI: -9.31 dL, -6.53 dL]), shorter operating room times (mean difference of -55.24 minutes [95% CI: -77.10 minutes, -33.39 minutes]), and less overall tumor recurrence (odds ratio = 0.23 [95% CI: 0.06, 0.91]) compared with resective surgery alone. Preoperative embolization had no impact on the development of postoperative new cranial nerve deficits not associated with embolization (odds ratio = 1.17 [95% CI: 0.47, 2.91]) and achievement of gross total resection (odds ratio = 1.92 [95% CI: 0.67, 5.53]). CONCLUSIONS Preoperative embolization may provide surgical efficiency with faster surgical times and less bleeding and safety with diminished overall recurrence via safe embolization with minimal risks. These results must be considered taking into account the nonrandomness of studies.
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Affiliation(s)
- Lucas P Mitre
- Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil.
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi F Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edson I Mitre
- Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil; Department of Otorhinolaryngology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Erion J de Andrade
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marcio S Rassi
- Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Peeters JB, Dessesard Olijnyk L, Janelle F, Shedid D, Bojanowski MW, Labidi M. Surgical management of tumors of the cervical spine and craniovertebral junction involving the vertebral artery: A narrative review. Neurochirurgie 2024; 70:101550. [PMID: 38552591 DOI: 10.1016/j.neuchi.2024.101550] [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: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The vertebral artery (VA) is in close proximity to bony structures, nerves and nerve sheaths of the cervical spine and craniovertebral junction (CVJ). These structures can be sources of tumors that are responsible for displacement, encasement and sometimes invasion of the VA. Removing these tumors while minimizing the risk of vascular injury requires thorough knowledge of the vascular anatomy, risk factors of vascular injury, the relationships of each tumor type with the VA, and the different surgical approaches and techniques that result in the best outcomes in terms of vascular control, tumoral exposure and resection. OBJECTIVE To present an overview of preoperative and anatomical considerations, differential diagnoses and various approaches to consider in cases of tumors in close relationship with the VA. METHOD A review of recent literature was conducted to examine the anatomy of the VA, the tumors most frequently affecting it, surgical approaches, and the necessary pre-operative preparations for ensuring safe and maximal tumor resection. This review aims to underscore the principles of treatment. CONCLUSION Tumors located at the CVJ and the cervical spine intimately involved with the VA, pose a surgical challenge and increase the risk of incomplete removal of the lesion. Detailed knowledge of the patient-specific anatomy and a targeted pre-operative work-up enable optimal planning of surgical approach and management of the VA, thereby reducing surgical risks and improving extent of resection.
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Affiliation(s)
- Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Leonardo Dessesard Olijnyk
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Felix Janelle
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada.
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Ghanaati H, Zarei D, Issaiy M, Ghavami N, Shakiba M, Zebardast J, Abbastabar H, Jalali AH, Firouznia K. Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications. Cardiovasc Intervent Radiol 2024; 47:416-431. [PMID: 38528173 DOI: 10.1007/s00270-024-03687-z] [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: 11/22/2023] [Accepted: 02/16/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). MATERIALS AND METHODS A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. RESULTS This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473-799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350-624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11-32%), and vagal nerve deficits in 22% (95% CI 13-31%). CONCLUSION This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data.
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Affiliation(s)
- Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Diana Zarei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbod Issaiy
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Ghavami
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Jayran Zebardast
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hedayat Abbastabar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
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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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Petrov A, Ivanov A, Kolomin E, Tukanov N, Petrova A, Rozhchenko L, Suvorova J. The Advantages of Non-Adhesive Gel-like Embolic Materials in the Endovascular Treatment of Benign Hypervascularized Lesions of the Head and Neck. Gels 2023; 9:954. [PMID: 38131940 PMCID: PMC10742558 DOI: 10.3390/gels9120954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES The use of non-adhesive gel-like embolic materials (NAGLEMs) in the endovascular treatment of hypervascularized formations in the head and neck is gaining in popularity because of a number of important characteristics involved. Their primary benefits are their capacity to penetrate diseased vasculature, effectively distribute, and, most importantly, remain controllable during the process. We reviewed the literature and evaluated the results of using NAGLEMs in comparison to other embolizing substances (namely, coils, glue, and particles) as alternative embolizing agents for patients receiving care at our clinic. The process comprised evaluating the safety, effectiveness, and technological elements of endovascular therapy used to treat two categories of hypervascular pathological abnormalities that were surgically corrected between 2015 and 2023. Arteriovenous malformations (AVMs) located in the head, neck, and paragangliomas with jugular/carotid body localization are combined by intense shunting blood flow and shared requirements for the embolic agent used in endovascular treatment (such as penetration, distribution, delayed polymerization, and controllability). An analysis of the literature was also conducted. Results showed 18 patients diagnosed with neck paragangliomas of the carotid body and jugular type. Five patients with arteriovenous malformation (AVM) of the face and neck were included, consisting of sixteen females and seven males with an average age of 55 ± 13 years. Endovascular procedures were performed using NAGLEMs (ONYX (Medtronic, Irvine, CA, USA), SQUID (Balt, Montmorency, France), and PHIL (Microvention, Tustin, CA, USA)) and dimethyl sulfoxide (DMSO)-compatible balloon catheters. All patients achieved complete or partial embolization of hypervascularized formations using one or more stages of endovascular treatment. Additionally, three AVMs of the face and two paragangliomas of the neck were surgically excised following embolization. In other instances, formations were not deemed necessary to be removed. The patients' condition upon discharge was assessed by the modified Rankin Scale (mRs) and rated between 0 and 2. CONCLUSION Currently, NAGLEMs are predominantly used to treat hypervascularized formations in the neck and head due to their fundamental properties. These properties include a lack of adhesion and a delay in predictable polymerization (after 30-40 min). NAGLEMs also exhibit excellent distribution and penetration throughout the vascular bed of the formation. Adequate controllability of the process is largely achieved through the presence of embolism forms of different viscosity, as well as excellent X-ray visualization.
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Affiliation(s)
- Andrey Petrov
- Vascular Neurosurgery Department, Polenov Neurosurgical Research Institute, Branch of Almazov National Medical Research Centre, 191014 Saint Petersburg, Russia; (A.I.); (E.K.); (N.T.); (A.P.); (L.R.); (J.S.)
- North-Western District Scientific and Clinical Center Named after L. G. Sokolov Federal Medical and Biological Agency, 194291 Saint Petersburg, Russia
| | - Arkady Ivanov
- Vascular Neurosurgery Department, Polenov Neurosurgical Research Institute, Branch of Almazov National Medical Research Centre, 191014 Saint Petersburg, Russia; (A.I.); (E.K.); (N.T.); (A.P.); (L.R.); (J.S.)
- North-Western District Scientific and Clinical Center Named after L. G. Sokolov Federal Medical and Biological Agency, 194291 Saint Petersburg, Russia
| | - Egor Kolomin
- Vascular Neurosurgery Department, Polenov Neurosurgical Research Institute, Branch of Almazov National Medical Research Centre, 191014 Saint Petersburg, Russia; (A.I.); (E.K.); (N.T.); (A.P.); (L.R.); (J.S.)
| | - Nikita Tukanov
- Vascular Neurosurgery Department, Polenov Neurosurgical Research Institute, Branch of Almazov National Medical Research Centre, 191014 Saint Petersburg, Russia; (A.I.); (E.K.); (N.T.); (A.P.); (L.R.); (J.S.)
| | - Anna Petrova
- Vascular Neurosurgery Department, Polenov Neurosurgical Research Institute, Branch of Almazov National Medical Research Centre, 191014 Saint Petersburg, Russia; (A.I.); (E.K.); (N.T.); (A.P.); (L.R.); (J.S.)
| | - Larisa Rozhchenko
- Vascular Neurosurgery Department, Polenov Neurosurgical Research Institute, Branch of Almazov National Medical Research Centre, 191014 Saint Petersburg, Russia; (A.I.); (E.K.); (N.T.); (A.P.); (L.R.); (J.S.)
| | - Julia Suvorova
- Vascular Neurosurgery Department, Polenov Neurosurgical Research Institute, Branch of Almazov National Medical Research Centre, 191014 Saint Petersburg, Russia; (A.I.); (E.K.); (N.T.); (A.P.); (L.R.); (J.S.)
- North-Western District Scientific and Clinical Center Named after L. G. Sokolov Federal Medical and Biological Agency, 194291 Saint Petersburg, Russia
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Li Q, Yu Y, Zhang L, Liu J, Ren H, Zhen X. Staged Surgery for Intra-Extracranial Communicating Jugular Foramen Paraganglioma: A Case Report and Systematic Review. Brain Sci 2022; 12:brainsci12091257. [PMID: 36138993 PMCID: PMC9496744 DOI: 10.3390/brainsci12091257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/01/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild tinnitus, headache, and dizziness, together with preoperative related imaging, was diagnosed with a left intra-extracranial communicating jugular foramen lesion in November 2015 and accepted an initial operation for the intracranial tumor by retrosigmoid approach. The pathologic report was paraganglioma. In November 2021, a subtotal resection of the extracranial tumor was conducted for prominent lower cranial nerves (LCNs) deficit and middle ear involvement by infratemporal approach. In patients with IECJFP accompanied by LCNs deficit and middle ear involvement, an initial surgery for extracranial lesion and a second procedure for intracranial tumor were appropriate. However, the first operation for the intracranial lesion was preferred in IECJFP cases without LCNs deficit and middle ear involvement, as it could remove compression to the neurovascular structure and brain stem, clarify a pathological diagnosis, avoid a CSF leak, and prevent a severe neurological disorder from extracranial lesion excision. Subtotal resection of the extracranial tumor would be performed when lesion became larger combined with obvious LCNs disorder and tympanic cavity involvement. Consideration of specific staged surgical strategy for IECJFP in accordance with preoperative LCNs deficit and tympanic cavity involvement could prevent critical postoperative neurological deficit and improve quality of life in the long term.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Department of Neurosurgery, Baotou Steel Group Third Staff Hospital, Baotou 014010, China
| | - Yanbing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
- Graduate School of Peking University Health Science Center, Beijing 100191, China
- Correspondence: ; Tel.: +86-185-1931-9666
| | - Li Zhang
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
- Graduate School of Peking University Health Science Center, Beijing 100191, China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School of Capital Medical University, Beijing 100069, China
| | - Hongxiang Ren
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xueke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
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Effects of CT/MRI Image Fusion on Cerebrovascular Protection, Postoperative Complications, and Limb Functional Recovery in Patients with Anterior and Middle Skull Base Tumors: Based on a Retrospective Cohort Study. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7855576. [PMID: 36159172 PMCID: PMC9489402 DOI: 10.1155/2022/7855576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
Abstract
Objective. To explore the effect of CT/MRI image fusion on cerebrovascular protection, postoperative complications and limb function recovery in patients with anterior and middle skull base tumors. Methods. During January 2019 to December 2021, a retrospective study was conducted on 50 patients who underwent anterior and middle skull base tumor resection in the same surgeon group in our hospital. According to the different surgical approaches, the patients were assigned to the fusion group (n = 29) and the routine group (n = 21). The routine group was operated with traditional operation, and the fusion group was operated with CT/MRI image fusion technique. The operation time, wound volume, resection rate and Karnofsky performance status (KPS), blood transfusion (vascular protection), tumor resection rate, and postoperative complications were compared. Results. The time of operation in the fusion group was shorter compared to the routine group, and the volume of the wound cavity in the fusion group was smaller compared to the routine group, and the difference was statistically significant (
). Following treatment, the KPS score of the fusion group was remarkably higher compared to the routine group, and the difference was statistically significant (
). The intraoperative blood transfusion rate in the fusion group was 17.24%, and the intraoperative blood transfusion rate in the routine group was 47.62%, and the difference was statistically significant (
). The resection rate in the fusion group (89.66%) was remarkably higher compared to the routine group (61.90%,
). The incidence of postoperative complications in the fusion group (6.90%) was remarkably lower compared to the control group (33.33%,
). Conclusion. The application of CT/MRI image-fusion technology can effectively enhance the clinical symptoms of patients with tumors in the anterior and middle region of the skull base, which can promote the prognosis, shorten the operation time, reduce unnecessary cerebral neurovascular injuries, and retain more brain functions.
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Mazur-Hart DJ, O'Neill BE, Pang BW, Hakar MH, Wood MD, Gupta S, Sayama CM, Liu JJ, Dogan A. Operative Technique: Angiomatoid Fibrous Histiocytoma—Unique Case and Management. J Neurol Surg Rep 2022; 83:e110-e118. [PMID: 36148089 PMCID: PMC9489471 DOI: 10.1055/s-0042-1754320] [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: 12/22/2021] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective
We describe the first jugular foramen angiomatoid fibrous histiocytoma (AFH) case and the first treatment with preoperative endovascular embolization. AFH is a rare intracranial neoplasm, primarily found in pediatric patient extremities. With an increase in AFH awareness and a well-described genetic profile, intracranial prevalence has also subsequently increased.
Study Design
We compare this case to previously reported cases using PubMed/Medline literature search, which was performed using the algorithm [“intracranial” AND “angiomatoid fibrous histiocytoma”] through December 2020 (23 manuscripts with 46 unique cases).
Patient
An 8-year-old female presented with failure to thrive and right-sided hearing loss. Work-up revealed an absence of right-sided serviceable hearing and a large jugular foramen mass. Angiogram revealed primary arterial supply from the posterior branch of the ascending pharyngeal artery, which was preoperatively embolized.
Intervention
Gross total resection was performed via a translabyrinthine approach.
Conclusion
The case presented is unique; the first reported AFH at the jugular foramen and the first reported case utilizing preoperative embolization. Preoperative embolization is a relatively safe technique that can improve the surgeon's ability to perform a maximally safe resection, which may decrease the need for adjuvant radiation in rare skull base tumors in young patients.
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Affiliation(s)
- David J. Mazur-Hart
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
| | - Brannan E. O'Neill
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
| | - Brandi W. Pang
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
| | - Melanie H. Hakar
- Department of Pathology and Laboratory Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Matthew D. Wood
- Department of Pathology and Laboratory Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Sachin Gupta
- Division of Otology/Neurotology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, United States
| | - Christina M. Sayama
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
| | - Jesse J. Liu
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
| | - Aclan Dogan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States
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AlEnazi A, Alshawi Y, Alnasser H, AlAftan M, AlQahtani M. Facial palsy following onyx embolization of a glomus tympanicum tumor: A case report and literature review. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_220_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Colli BO, Junior CGC, de Oliveira RS, Gondim GGP, Abud DG, Massuda ET, de Melo Filho FV, Tanaka K. Surgical management of embolized jugular foramen paragangliomas without facial nerve transposition: Experience of a public tertiary hospital in Brazil. Surg Neurol Int 2021; 12:482. [PMID: 34754532 PMCID: PMC8571183 DOI: 10.25259/sni_651_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Jugular foramen paragangliomas (JFP) treatment represents a challenge for surgeons due to its close relationship with facial nerve (FN), lower cranial nerves (LCN), and internal carotid artery. Due to its hypervascularization, preoperative tumor embolization has been indicated. Methods: Retrospective analysis of the clinical evolution of 26 patients with JFP class C/D previously embolized treated through infratemporal/cervical access without FN transposition. Results: Total and subtotal resections were 50% each, regrowth/recurrence were 25%, and 23%, respectively, and mortality was 3.9%. Postoperatively, 68.4% of patients had FN House and Brackmann (HB) Grades I/II. New FN deficits were 15.4% post embolization and 30.7% postoperatively. Previous FN deficits worsened in 46.1%. Tumor involved the FN in 30.8% and in 62.5% of them these nerves were resected and grafted (60% of them had HB III). Lateral fall, ear murmur, and vertigo improved in all patients. Tinnitus improved in 77.8% and one patient developed tinnitus after surgery. Hearing loss did not improve, eight partial hearing loss remained unchanged and four worsened. New postoperative LCN deficits were 64.3%. Postoperative KPS between 80 and 100 dropped 8.3%. Two patients with secretory paragangliomas with arterial hypertension difficult to control had better postoperative blood pressure control. Conclusion: Although still with significant morbidity due to FN and LCN injuries, the treatment of patients with JFP Fisch C/D has good long-term results. Surgical techniques without FN transposition have less intraoperative nerve damage, lower rates of total resection, and higher recurrence. Preoperative embolization of JFP reduces the intraoperative blood loss but can cause FN deficit.
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Affiliation(s)
- Benedicto Oscar Colli
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carlos Gilberto Carlotti Junior
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Gozzoli Podolski Gondim
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Medical Image, Hematology and Clinical Oncology Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansanti Abud
- Department of Medical Image, Hematology and Clinical Oncology Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Tanaka Massuda
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Veríssimo de Melo Filho
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Koji Tanaka
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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11
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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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12
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Helal A, Vakharia K, Brinjikji W, Carlson ML, Driscoll CL, Van Gompel JJ, Link MJ, Cloft H. Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective. Interv Neuroradiol 2021; 28:145-151. [PMID: 34034540 DOI: 10.1177/15910199211019175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Ahmed Helal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kunal Vakharia
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Matthew L Carlson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Colin Lw Driscoll
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Harry Cloft
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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13
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Moreno-Paredes S, Rodríguez-Alcalá L, Martín-Lagos Martínez J, Müller Locatelli N, Vázquez López C, Vargas Fernández JL, Cabrera Peña Á. Facial palsy after embolization with Squid® 12. BMC Neurol 2021; 21:45. [PMID: 33514324 PMCID: PMC7847177 DOI: 10.1186/s12883-021-02064-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
Endovascular procedures with liquid embolic agents such as ethylene-vinyl alcohol (EVOH) copolymers are indicated before surgical treatment of cervical paraganglioma. Consequently, these agents are now available as low viscosity formulations, one of which is Squid 12, which are demonstrating superior vascular penetration. Cases of facial paralysis secondary to embolization of cervical vascular lesions with classic embolic agents have been reported in the English literature, however, this complication has not been described with new generation options such as Squid 12. We describe the case of a 43-year-old patient with a left neck carotid paraganglioma. Embolization was performed under general anaesthesia before surgical excision. In the immediate postoperative period, the patient developed total left facial palsy. Since the imaging tests (Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)) and neurological examination showed no involvement of additional cranial nerves (CN), we hypothesise that the main cause of this complication is ischemia of the vasa nervorum of CN VII secondary to embolization. Almost six months later, the patient continues to present total facial paralysis (Grade VI House-Brackmann facial paralysis scale), and palsy of the left CN X and XII as a complication secondary to surgical resection of the paraganglioma. This case is relevant since it is the first clinical case of permanent facial paralysis secondary to embolization with Squid 12.
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Affiliation(s)
- Santiago Moreno-Paredes
- Department of Otorhinolaryngology, Hospital Clínico Universitario San Cecilio, Granada, Spain.
| | - Laura Rodríguez-Alcalá
- Department of Otorhinolaryngology, Hospital Clínico Universitario San Cecilio, Granada, Spain
| | | | | | - Cristina Vázquez López
- Department of Otorhinolaryngology, Hospital Clínico Universitario San Cecilio, Granada, Spain
| | | | - Álvaro Cabrera Peña
- Department of Interventional Radiology, Hospital Clínico Universitario San Cecilio, Granada, Spain
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