Michelozzi Caterina, Januel Anne Christine, Cuvinciuc Victor, Tall Philippe, Bonneville Fabrice, Fraysse Bernard, Deguine Olivier, Serrano Elie, Cognard Christophe
Dipartimento di Radiologia diagnostica e Interventistica, Scuola di Specialità di Radiodiagnostica, Università degli Studi di Milano, Ospedale Sanpaolo, Milano, Italy Neuroradiology Department, University Hospital of Purpan, Toulouse, France.
Neuroradiology Department, University Hospital of Purpan, Toulouse, France.
J Neurointerv Surg. 2016 Jun;8(6):626-35. doi: 10.1136/neurintsurg-2014-011582. Epub 2015 May 2.
To report the morbidity and long term results in the treatment of paragangliomas by transarterial embolization with ethylene vinyl alcohol (Onyx), either as preoperative or palliative treatment.
Between September 2005 and 2012, 18 jugulotympanic, 7 vagal, and 4 carotid body paragangliomas (CBPs) underwent Onyx embolization, accordingly to our head and neck multidisciplinary team's decision. CBPs were embolized preoperatively. Jugulotympanic and vagal paragangliomas underwent surgery when feasible, otherwise palliative embolization was carried out alone, or in combination with radiotherapy or tympanic surgery in the case of skull base or tympanic extension. Treatment results, and clinical and MRI follow-up data were recorded.
In all cases, devascularization of at least 60% of the initial tumor blush was obtained; 6 patients underwent two embolizations. Post-embolization, 8 patients presented with cranial nerve palsy, with partial or complete regression at follow-up (mean 31 months, range 3-86 months), except for 2 vagal and 1 hypoglossal palsy. 10 patients were embolized preoperatively; 70% were cured after surgery and 30% showed residual tumor. 19 patients received palliative embolization, of whom 5 underwent radiotherapy and 3 received tympanic surgery post-embolization. Long term follow-up of palliative embolization resulted in tumor volume stability (75%) or extension in intracranial or tympanic compartments. Onyx embolization of CBPs resulted in more difficult surgical dissection in 2 of 4 cases.
Onyx embolization is a valuable alternative to surgery in the treatment of jugulotympanic and vagal paragangliomas; tympanic surgery or radiosurgery of the skull base should be considered in selected cases. Preoperative Onyx embolization of CBPs is not recommended.
报告采用乙烯-乙烯醇共聚物（Onyx）经动脉栓塞术治疗副神经节瘤的发病率及长期治疗结果，该治疗方法可用于术前或姑息治疗。
2005年9月至2012年期间，根据我们头颈多学科团队的决定，对18例颈静脉鼓室副神经节瘤、7例迷走神经副神经节瘤和4例颈动脉体副神经节瘤（CBP）进行了Onyx栓塞术。CBP在术前进行栓塞。颈静脉鼓室副神经节瘤和迷走神经副神经节瘤在可行的情况下接受手术治疗，否则单独进行姑息性栓塞，或者在肿瘤侵犯颅底或鼓室时联合放疗或鼓室手术。记录治疗结果以及临床和MRI随访数据。
所有病例均实现了至少60%的初始肿瘤染色去血管化；6例患者接受了两次栓塞。栓塞后，8例患者出现脑神经麻痹，随访时部分或完全恢复（平均31个月，范围3 - 86个月），但有2例迷走神经麻痹和1例舌下神经麻痹未恢复。10例患者术前接受了栓塞；70%的患者术后治愈，30%有残留肿瘤。19例患者接受了姑息性栓塞，其中5例在栓塞后接受了放疗，3例接受了鼓室手术。姑息性栓塞的长期随访结果显示肿瘤体积稳定（75%）或在颅内或鼓室区域有扩展。4例CBP中有2例在Onyx栓塞后手术分离难度增加。
Onyx栓塞术是治疗颈静脉鼓室副神经节瘤和迷走神经副神经节瘤的一种有价值的替代手术方法；在某些特定病例中应考虑鼓室手术或颅底放射外科手术。不建议对CBP进行术前Onyx栓塞。
