Direct N-butyl-2-cyanoacrylate injections to the head and neck for percutaneous embolized devascularization

Abstract

Background: N-butyl-2-cyanoacrylate (NBCA) has been used for vascular malformations since the 1980s; however, few studies have looked at applications, procedural techniques, and outcome throughout many institutions. Herein, we review applications, procedural techniques, previous literature, and outcomes for the use of NBCA specifically through percutaneous technique in treating head and neck vascular pathology. Methods: An extensive literature review using PubMed database with published literature containing “N-butyl-2-cyanoacrylate embolization,” was performed. No date restrictions were used. Cross-checking of articles was conducted to exclude duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic. Results: The search yielded 1124 related articles. When comparing surgical resection to embolization with NBCA for cerebral AVMs, complications were similar in both groups and included hemorrhage (15%), residual AVM (6%), and cerebrospinal fluid leak (3%). Their mortality rate was 3% in both groups. Preoperative percutaneous embolization does show improved surgical outcomes. Conclusion: NBCA is a fast-acting liquid embolic material used in the treatment of a variety of vascular malformations and lesions of the head and neck. Investigations surrounding the use of NBCA injections as a new alternative embolic agent began in the 1980’s. Administration of NBCA has been shown to be useful in minimizing intraoperative blood loss and controlling acute hemorrhage. Performing percutaneous embolization with NBCA provides a successful alternative for surgeons when transcatheter embolization techniques may prove to be too difficult to perform. Embolization using NBCA will continue to play in integral role in the treatment of malignant lesions and vascular malformations. Continued research is warranted to improve safety, outcomes, and further develop clinical applications of NBCA.

The Use of Histoacryl Injections to Treat Subgaleal Cerebrospinal Fluid Collection After Cranioplasty

“…Histoacryl is most commonly used to achieve skin closure when no tension is present [22][23][24][25] but can also be used to affix surgical mesh when performing hernia surgery [26][27][28][29][30] and for sclerotherapy to repair bleeding and nonbleeding esophageal varices. [31][32][33][34][35] In the neurosurgical field, Histoacryl has been used for skin closure 36 or embolization for vascular pathologies [37][38][39][40][41] ; it has also been used to control CSF leakage and reconstruct the sellar floor after endoscopic surgery. 42 The most important method to prevent CSF leakage is to create a watertight dural closure.…”

Pedicled multifidus muscle flaps to treat dural tears due to penetrating spinal stab wounds: Two case reports and a literature review

“…[9] erefore, most penetrating spinal injuries are treated surgically utilizing laminectomy, resection of retained foreign bodies, including knife blades, removal/decompression of hematomas, and exploration/ watertight closure involving direct/indirect dural repairs. [2,3,6,8] Lack of success with spinal drain placement for these DT/CSF fistulas has included overdrainage, pneumocephalus, intracranial hemorrhages, and meningitis (i.e., 3-8%). [2,7] Rather, pedicle multifidus muscle flaps are effective alternatives for managing such penetrating spinal dural lacerations [Figures 5 and 6].…”

“…Penetrating spinal injuries may result in dural tears (DT)/cerebrospinal fluid (CSF) leaks that can result in wound infections, meningitis, and abscesses. [2,3,6,8] Although direct dural suturing is the gold standard for repairing DT, [5] non-suturable lacerations may require indirect dural repair utilizing grafts and/or pedicle multifidus muscle flaps. [1,4,10] Here, we reviewed two cases [Table 1] and the literature defining the safety, efficacy, pros and cons of utilizing grafts and/or pedicle multifidus muscle flaps to repair spine-trauma-related DT/CSF fistulas.…”

Head and Neck Arteriovenous Malformations: Clinical Manifestations and Endovascular Treatments

“…Liquid embolic material: This type of material is fre-quently used for the embolization of AVMs owing to its permanent embolic effect and the wide occlusivity from feeders to drainers via arteriovenous fistulas and perifistulous arterial anastomoses. n-Butyl-2-cyanoacrylate (NBCA) is the monomeric form of a frequently used material for the treatment of intra-and extracranial AVMs using endovascular or percutaneous approaches; this material solidifies by polymerization upon coming into contact with the ionic component of the blood [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. It is characterized as an adhesive type; the adhesive effect, polymerization time, and radioopacity can vary with the ratio of mixing with Lipiodol (Guerbet, Paris, France).…”