Interventional Management of Head and Neck Tumors

Abstract

Advancements in medical imaging and device technology allow minimal invasive procedures for the diagnosis and treatment of various disorders. For the management of tumors in head and neck region, these image-guided interventions play essential role in the often used multidisciplinary approach. Tissue sampling under ultrasound or computed tomography guidance is generally the first step to reach a pathological diagnosis. For head and neck tumors with high vascularity, embolization using particulate matter, liquid embolic agents, or coils is used to achieve successful tumor resection with minimal blood loss. Hemorrhage related to head and neck tumors can be evaluated and managed with endovascular techniques with minimal morbidity and mortality. Intra-arterial chemotherapy, radiofrequency ablation, and cryotherapy are new techniques for the management of advanced head and neck cancer which may serve as an alternative to achieve locoregional control and survival when curative resection may not be feasible.

Preoperative Endovascular Embolization of Intracranial Hemangioma: A Case Report

“…Preoperative embolization of highly vascularized head and neck tumors was first described in 1974 when Hekster et al reported that meningioma embolization could reduce the amount of bleeding at the time of surgery, increase the likelihood of successful tumor resection, and shorten the operative time and postoperative recovery period. 2 The benefit in regards to reducing intraoperative bleeding was more pronounced, especially for larger, high-grade, and more vascularized tumors such as paraganglioma, angiofibroma, hemangiopericytoma, meningioma, hemangioblastoma, schwannoma, juvenile nasopharyngeal angiofibroma, and hypervascular metastases. 2,4,14 There are several goals of preoperative embolization: (1) to control hardly accessible feeder arteries; 15 (2) to reduce intraoperative bleeding; 15 (3) to shorten procedural time; (4) to increase the chances of successful total resection; 4 (5) to reduce the damage of surrounding normal tissue; 16 (6) palliative therapy to reduce intractable pain; 17 (7) to reduce tumor recurrence; (8) to improve visualization of the surgical field.…”

“…2 The benefit in regards to reducing intraoperative bleeding was more pronounced, especially for larger, high-grade, and more vascularized tumors such as paraganglioma, angiofibroma, hemangiopericytoma, meningioma, hemangioblastoma, schwannoma, juvenile nasopharyngeal angiofibroma, and hypervascular metastases. 2,4,14 There are several goals of preoperative embolization: (1) to control hardly accessible feeder arteries; 15 (2) to reduce intraoperative bleeding; 15 (3) to shorten procedural time; (4) to increase the chances of successful total resection; 4 (5) to reduce the damage of surrounding normal tissue; 16 (6) palliative therapy to reduce intractable pain; 17 (7) to reduce tumor recurrence; (8) to improve visualization of the surgical field. 18 Considering that hemangioma is a type of tumor with high vascularity, preoperative tumor embolization was performed to reduce intraoperative risk and maximize the success of resection.…”

“…Super-selective angiography of extracranial carotid artery branches can confirm the feeder artery and identify other selective contributions from various branches, especially when multiple feeders are present. 2 Collateral pathways can open due to an increase in intracranial pressure, and the injection of an embolic agent can result in a hazardous neurological deficit. 2 In our case, a feeder from the frontal branch of the middle meningeal artery was identified with no dangerous collaterals.…”

“…2 Collateral pathways can open due to an increase in intracranial pressure, and the injection of an embolic agent can result in a hazardous neurological deficit. 2 In our case, a feeder from the frontal branch of the middle meningeal artery was identified with no dangerous collaterals.…”

“…1 Endovascular embolization is often used in conjunction with surgical techniques in an attempt to minimize mortality, morbidity and increase the chances of successful tumor resection. 2 Hekster et al reported the first successful tumor embolization case in 1974, when they used transfemoral catheterization to embolize a meningioma. 3 Since then, many reports and case series have been published describing the advantages of the procedure.…”