1
|
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; 45:1499-1505. [PMID: 38719606 PMCID: PMC11448997 DOI: 10.3174/ajnr.a8328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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: 9] [Impact Index Per Article: 4.5] [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.
Collapse
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
| |
Collapse
|