Department of Radiology, Baskent Universitesi Tip Fakultesi Hastanesi, Fevzi Cakmak Cd. 10., Sk. No. 45, 06490, Bahcelievler/Ankara, Turkey.
Cardiovasc Intervent Radiol. 2010 Oct;33(5):967-75. doi: 10.1007/s00270-010-9803-4. Epub 2010 Jan 22.
Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32-82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.
经动脉栓塞术在头颈部副神经节瘤的应用中已被证实可减少术中出血。然而，由于广泛的血管结构和动静脉分流，该手术通常无法完全完成。我们报告了通过直接穿刺和瘤内注射正丁基氰基丙烯酸酯（NBCA）或 Onyx 治疗这些病变的经验。10 例年龄 32-82 岁的患者因术前栓塞 7 例颈动脉体瘤和 3 例颈静脉副神经节瘤而被回顾性分析。在 4 例肿瘤有多个小口径动脉供血且在 6 例肿瘤存在不完全血管阻断的情况下，主要进行瘤内注射。穿刺在超声引导下进行，注射在路图透视引导下进行。栓塞前后进行详细的血管造影。控制性血管造影显示所有肿瘤均完全或接近完全血管阻断。3 例有多个小口径动脉供血的肿瘤采用 NBCA 直接注射治疗。1 例肿瘤在 Onyx 初次注射后需要进行经动脉栓塞治疗。6 例肿瘤在经动脉入路后，出现了来自血管丛或颈外动脉小分支的区域性血管化，这些区域采用 NBCA 注射栓塞。栓塞过程中未发生与栓塞相关的技术或临床并发症。除 1 例外，所有肿瘤在栓塞后均被手术切除。总之，对于有多个小口径动脉供血的头颈部副神经节瘤和经动脉栓塞后存在不完全血管阻断的情况，经皮直接注射 NBCA 或 Onyx 进行术前血管阻断是可行、安全且有效的。
