Facial palsy after glomus jugulare tumour embolization

Marangos, N.; Schumacher, Martin

doi:10.1017/s0022215100143762

Cited by 44 publications

(32 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To our knowledge, only 4 cases of cranial nerve palsy from PVA have been reported since the 1980s, and all resolved. 9,11,18,19 The low incidence of cranial nerve morbidity can be explained by the use of large particles that typically do not reach the vasa nervosa. Furthermore, because particulate embolics are known to dissipate over time, cranial neuropathies noted following PVA emboliza tion have tended to recover, because of early recanalization of branches feeding the cranial nerves.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, because particulate embolics are known to dissipate over time, cranial neuropathies noted following PVA emboliza tion have tended to recover, because of early recanalization of branches feeding the cranial nerves. [9][10][11]15,19 Although recanalization of the tumor can also occur, it is generally not a concern, especially if the resection is performed in a timely manner after embolization. On the other hand, Onyx is believed to result in more permanent occlusion of the vasculature, which may explain the permanency of cranial nerve palsies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx

Gaynor¹,

Elhammady²,

Jethanamest

et al. 2014

JNS

View full text Add to dashboard Cite

Object The resection of glomus jugulare tumors can be challenging because of their inherent vascularity. Preoperative embolization has been advocated as a means of reducing operative times, blood loss, and surgical complications. However, the incidence of cranial neuropathy associated with the embolization of these tumors has not been established. The authors of this study describe their experience with cranial neuropathy following transarterial embolization of glomus jugulare tumors using ethylene vinyl alcohol (Onyx, eV3 Inc.). Methods The authors retrospectively reviewed all cases of glomus jugulare tumors that had been treated with preoperative embolization using Onyx at their institution in the period from 2006 to 2012. Patient demographics, clinical presentation, grade and amount of Onyx used, degree of angiographic devascularization, and procedural complications were recorded. Results Over a 6-year period, 11 patients with glomus jugulare tumors underwent preoperative embolization with Onyx. All embolization procedures were completed in one session. The overall mean percent of tumor devascularization was 90.7%. No evidence of nontarget embolization was seen on postembolization angiograms. There were 2 cases (18%) of permanent cranial neuropathy attributed to the embolization procedures (facial nerve paralysis and lower cranial nerve dysfunction). Conclusions Embolizing glomus jugulare tumors with Onyx can produce a dramatic reduction in tumor vascularity. However, the intimate anatomical relationship and overlapping blood supply between these tumors and cranial nerves may contribute to a high incidence of cranial neuropathy following Onyx embolization.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx

Gaynor¹,

Elhammady²,

Jethanamest

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…In the literature, new postoperative cranial nerve deficits occurred in 22% to 59% of patients, including 5% to 25% facial nerve dysfunction at follow-up [15,20]. Other complications of surgery included cerebrospinal fluid (CSF) leakage (8.3%), meningitis (2.1%), aspiration (5.5%), pneumonia (2.3%), wound infection (5.5%), intracranial haemorrhage, cerebrovascular accident and ileus (each 1.6%) [11].…”

Section: Complication's Avoidancementioning

confidence: 99%

“…Embolization has been used as an adjunct to surgery and to palliate symptoms, but we are unaware of anyone using a consistent strategy of embolization alone or in conjunction with radiosurgery. It should be remembered that embolization is associated with risks of injuring the cranial nerves as well [20,23]. The indications for radiosurgical treatment of these lesions depend on the goals of treatment and on the relative morbidity associated with radiosurgical therapy.…”

Section: Radiosurgerymentioning

confidence: 99%

Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases

et al. 2011

View full text Add to dashboard Cite

Jugular foramen paragangliomas are rare skull base tumours posing multiple complex diagnostic and management problems. We did a study to evaluate surgical technique, outcome and complications in 75 cases of tumours treated by multidisciplinary approach (i.e. combined neurosurgery, neuroradiology, ear, nose and throat surgery and intensive care unit team). Retrospective study on 75 consecutive patients with jugular foramen paragangliomas treated surgically from 1989 to 2005. Preoperative balloon occlusion test was performed in all patients as well as embolization (100%). A combined limited infratemporal and juxtacondylar approach was used in all patients. Gross total resection was achieved in 59 patients (78.7%). The most common complication was represented by lower cranial nerve deficits in five patients (6.6%), which was only temporary in three. Postoperative facial nerve weakness occurred in five cases (6.6%) and resolved in three of them. The remaining two patients underwent facial nerve reconstruction by hypoglossal/facial nerve anastomosis. Four patients (5.3%) had a postoperative cerebrospinal fluid leak, which was successfully treated by lumbar drainage. Two patients (2.7%) died because of complications related to surgical injury of lower cranial nerves: one patient developed aspiration pneumonia and septicemia and the second one developed a large cervico-bulbar hematoma that led to severe respiratory distress and ultimately global cerebral hypoxia. Paragangliomas are rare and complex skull base lesions that may be managed with low morbidity and mortality if a multidisciplinary approach is considered. Facial and lower cranial nerve postoperative deficits can be limited.

show abstract

“…Without this knowledge, disastrous neurologic consequences such as a stroke may result [9]. Other serious complications like cranial nerve deficits have been reported after embolization of paragangliomas as well [13,23]. Generally, the risk of potential complications from embolization always have to be weighed against the advantages, which include improved surgical exposure, resection and morbidity as well as reduction of intraoperative blood loss [9].…”

Section: Role Of Preoperative Embolizationmentioning

confidence: 99%

Paragangliomas of the head and neck: diagnosis and treatment

2005

View full text Add to dashboard Cite

Paragangliomas of the head and neck (HNP) represent rare tumors of neural crest origin. They are highly vascular neoplasms that are benign in the majority of cases. The site of origin defines the name given those tumors. In the head and neck, they most commonly occur at the carotid bifurcation, where they are referred to as carotid body tumors (CBT). Other common sites of origin are the jugular bulb (jugular paraganglioma; JP), the tympanic plexus on the promontory (tympanic paraganglioma; TP) and the vagal nerve (vagal paraganglioma; VP). Patients with cervical paragangliomas frequently present with a painless, slowly enlarging mass in the lateral neck. In many patients with TP and JP, tinnitus and hearing loss are early symptoms. JP patients often suffer from lower cranial nerve deficits. Evaluation by an imaging modality is necessary to establish the diagnosis. Imaging procedures frequently used include B-mode sonography with color-coded Doppler sonography, computed tomography (CT), magnetic resonance imaging (MRI) and digital substraction angiography (DSA). Debate exists in the literature regarding the different treatment modalities for paragangliomas which include surgery, radiotherapy and stereotactic radiosurgery. The role of preoperative angiography and embolization has also been a matter of discussion. The diagnostic work up and the different treatment options for patients with head and neck paragangliomas will be presented and discussed.

show abstract

Facial palsy after glomus jugulare tumour embolization

Cited by 44 publications

References 6 publications

Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx

Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx

Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases

Paragangliomas of the head and neck: diagnosis and treatment

Contact Info

Product

Resources

About