Clinical study of preoperative angiography and embolization of hypervascular neoplasms in the oral and maxillofacial region.

OBJECTIVE

The purpose of this study was to investigate the angiographic features of hypervascular head and neck neoplasms and to evaluate the effects of embolization on these lesions.

METHODS

Angiograms and operation records of 25 patients with hypervascular neoplasms (23 neck paragangliomas, 1 hemangiopericytoma, and 1 hemangioendothelioma) were retrospectively analyzed, and the effects of 8 embolization procedures were estimated.

RESULTS

Angiograms demonstrated that 23 neck paragangliomas (NPs) were manifested as richly vascularized lesions, and were divided into 3 types. Type I NPs (n = 2) were located cranial-laterally to the carotid bifurcation, and were removed with an intact carotid artery and injured vagus nerve. Type II (n = 17) lesions widened the bifurcations in 16 of 17 cases. During the operation, the continuity of the internal carotid arteries was preserved in 15 of 17 cases. Type III (n = 4) lesions enveloped the carotid bifurcations, and were removed together with the bifurcations in 3 of 4 cases. In 6 type II paraganglioma cases intra-arterial embolization was employed and the paragangliomas were removed with less blood loss (238 mL) than the nonembolized group (600 mL). Additionally, the infratemporal hemangiopericytoma and the parotid hemangioendothelioma were embolized and removed uneventfully.

CONCLUSIONS

Angiographic studies are highly valuable for the diagnosis and preoperative analysis of hypervascular head and neck neoplasms. Also, embolization therapy may minimize intraoperative blood loss. Both methods should be employed in a team approach to lesion treatment.