Preoperative Embolization of Paragangliomas (Glomus Tumors) of the Head and Neck: Histopathologic and Clinical Features

Pauw, Bernard K. H.; Makek, M; Fisch, Ugo; Valavanis, Anton

doi:10.1055/s-2008-1060563

Cited by 36 publications

(15 citation statements)

References 8 publications

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“…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%

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

Gaynor¹,

Elhammady²,

Jethanamest

et al. 2014

JNS

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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.

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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

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“…Preoperative embolization can reduce intraoperative blood loss significantly. This is especially true for vagal and jugulotympanic paragangliomas [39,43]. In these tumor localizations, an occlusion test is also recommended to check the possibility to sacrifice the internal carotid artery during radical surgery for jugulotympanic paragangliomas.…”

Section: Imaging Of Head and Neck Paragangliomasmentioning

confidence: 98%

Imaging and management of head and neck paragangliomas

2005

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Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). Diagnostic imaging can be considered in two clinical situations: (1) patients who present with clinical symptoms suggestive of a paraganglioma, and (2) individuals from families with hereditary paragangliomas. It is not only necessary to detect and characterize the lesion, but also to study the presence of multiplicity. For these purposes, MR imaging, and especially 3D TOF MRA, is the modality of choice. CT scanning is especially useful to show destruction of the temporal bone. Angiography in combination with embolization will mainly be used prior to surgical resection, but can also be used for diagnostic purposes when the diagnosis is not yet clear. Many parameters play a role in the decision to treat of which multifocality and impairment of cranial nerves are the most important. The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Resection however, should be balanced against a more conservative "wait and scan" policy or palliative treatments such as radiotherapy.

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“…Such circumstances necessitate a substitution with thyroxine, vitamin D, and calcium. 23 In the case presented here, postoperatively, thyroid and parathyroid hormones were arranged in the reference range, indicating that no serious injury of the respective glands has occurred. Nevertheless, a periodical checkup is recommended also to control problems associated with prematurity in our patient, especially the neurologic outcome.…”

Section: Discussionmentioning

confidence: 88%

“…This is especially true for vagal and jugulotympanic paragangliomas. 10,23 The benefit of performing a preoperative embolization for carotid body tumors and TPs is poor. Hemostasis can easily be achieved during resection of carotid body tumors when the course of the ascending pharyngeal artery is taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

Kissing Molars

Boffano

Gallesio

2009

Journal of Craniofacial Surgery

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Kissing molars are an extremely rare condition. They are impacted permanent molars that have occlusal surfaces contacting each other in a single follicular space with roots pointing in opposite directions. Unfortunately, because of the rarity of this clinical finding, it is difficult to propose clinical procedure protocols. In this article, we report the management of a patient with kissing molars.

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Preoperative Embolization of Paragangliomas (Glomus Tumors) of the Head and Neck: Histopathologic and Clinical Features

Abstract: Preoperative embolization of paragangliomas (glomus tumors) is widely used to devascularize glomus tumors

Cited by 36 publications

References 8 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

Imaging and management of head and neck paragangliomas

Kissing Molars

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