Onyx embolization of skull base paragangliomas: a single-center experience

Catapano, Joshua S; Almefty, Rami O.; Ding, Dale; Whiting, Alexander C; Pines, Andrew R.; Richter, Kent R.; Ducruet, Andrew F; Albuquerque, Felipe C

doi:10.1007/s00701-019-04127-5

Cited by 18 publications

(17 citation statements)

References 38 publications

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“…[ 19 ] Based on NF nourishment, the probability of post embolization injury was estimated at 6%[ 19 ] and in the literature, it ranges from 0% to 14.2% (mean 5%). [ 7 , 10 , 17 , 18 , 25 , 34 , 39 ] The NF lesions observed in two (18.2%) of our patients occurred after partial and subtotal embolization, which suggests that post embolization NF lesions are more related to their vascularization than to the extension of embolization. After our present results, we indicate preoperative embolization only in large and highly vascularized tumors, especially if the patient already has FN deficit.…”

Section: Discussionmentioning

confidence: 81%

“…[ 2 , 30 , 33 ] Preoperative JFP embolization has been advocated to reduce bleeding during tumor resection. [ 7 , 10 , 17 , 18 , 33 , 34 , 39 ] However, embolization can occlude the blood supply to low cranial nerves (LCN), making them more susceptible to injury during dissection. [ 17 ] Although the surgical resection appears to be the most effective treatment for these tumors, technical details as previous embolization, the best approach or transposition or not of the FN are controversial.…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of embolized jugular foramen paragangliomas without facial nerve transposition: Experience of a public tertiary hospital in Brazil

Colli

Carlotti

Oliveira

et al. 2021

Surgical Neurology International

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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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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Surgical management of embolized jugular foramen paragangliomas without facial nerve transposition: Experience of a public tertiary hospital in Brazil

Colli

Carlotti

Oliveira

et al. 2021

Surgical Neurology International

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“…al, 15 out of 45 patients who underwent Onyx embolization developed neurological deficits, with ipsilateral facial palsy being the most common. 6 Use of NBCA or onyx can generate reflux into larger more proximal vessels and may limit blood supply to branches that feed portions of nerves, such as the middle meningeal branches serving the mastoidal segment of the facial nerve, seen more recently with middle meningeal artery and juvenile nasopharyngeal angiofibroma embolization. 20,21 Data from previous literature supports the safety profile of PVA particle embolization, with very few reported incidences of post-embolization cranial neuropathies since its utilization in the 1980s.…”

Section: Discussionmentioning

confidence: 99%

“…Data from liquid agent embolization reported a slightly lower operative EBL, however we believe it does not add clinical benefit. 6,24…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] Multiple agents have been used for tumor embolization including cyanoacrylate glue (NBCA), polyvinyl alcohol (PVA), and ethylene vinyl alcohol (Onyx). 6,7 Despite its theoretical value, evidence from previous literature has been inconsistent due to the increased risk of postembolization cranial nerve paresis, minimal benefit in reducing transfusion requirements, and intra-operative cranial nerve injury regardless of a decrease in operative blood loss and operative time. 6,[8][9][10] Understanding the hypertrophied feeding vessels from both anterior and posterior cranial circulations and their bony arterial feeders can be complicated in this region.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective

Helal

Vakharia

Brinjikji³

et al. 2021

Interv Neuroradiol

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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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Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications

Ghanaati,

Zarei,

Issaiy

et al. 2024

Cardiovasc Intervent Radiol

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Onyx embolization of skull base paragangliomas: a single-center experience

Cited by 18 publications

References 38 publications

Surgical management of embolized jugular foramen paragangliomas without facial nerve transposition: Experience of a public tertiary hospital in Brazil

Surgical management of embolized jugular foramen paragangliomas without facial nerve transposition: Experience of a public tertiary hospital in Brazil

Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective

Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications

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