Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2020 Apr;136:178-183. doi: 10.1016/j.wneu.2020.01.073. Epub 2020 Jan 16.
Jugular foramen paragangliomas are highly vascular tumors known to have significant venous hemorrhage during resection even after conventional transarterial embolization. The authors report a novel technique to the endovascular embolization of jugular foramen paragangliomas using a combined transarterial and transvenous access for better intraoperative control of blood loss and visualization.
This is a retrospective data collection of 2 patients diagnosed with jugular foramen paragangliomas with novel embolization technique and surgical resection.
Two patients underwent embolization of jugular foramen paragangliomas through combined transarterial and transvenous routes using 2 double-lumen balloon microcatheters. In both cases, single arterial vessel embolization was performed through the occipital artery in Case 1 and the tympanic branch of the ascending pharyngeal artery in Case 2. Simultaneously, balloon microcatheter occlusion in the sigmoid sinus and single venous outflow vessel embolization was performed. Near-complete occlusion was established, with angiographic disappearance of tumor blush. Surgical resection was performed in both cases. Estimated blood loss BL was 600 mL in Case 1 and 200 mL in Case 2. No blood transfusions were required, intraoperatively or postoperatively. There were no cranial nerve deficits post embolization. One patient had a persistent House Brackman 2 facial nerve palsy after resection.
The initial experience with simultaneous transvenous and transarterial paraganglioma embolization demonstrated the safety of the technique and superior embolic agent penetration. This was supported by our observations during embolization and intraoperatively during tumor resection. Additional patients need to be treated with this technique for better assessment of long-term efficacy and incidence of embolization-related cranial neuropathies.
颈静脉孔副神经节瘤是一种高度血管化的肿瘤，即使在常规经动脉栓塞后，在切除过程中也会发生明显的静脉出血。作者报告了一种新的技术，即通过联合动脉内和静脉内入路对颈静脉孔副神经节瘤进行血管内栓塞，以便更好地控制术中失血量和可视化。
这是对 2 例采用新的栓塞技术和手术切除诊断为颈静脉孔副神经节瘤的患者进行的回顾性数据收集。
2 例患者均通过联合动脉内和静脉内入路，使用 2 个双腔球囊微导管对颈静脉孔副神经节瘤进行栓塞。在这两种情况下，通过枕动脉（病例 1）和咽升动脉鼓室支（病例 2）进行单一动脉血管栓塞。同时，对乙状窦和单一静脉流出血管进行球囊微导管闭塞栓塞。建立了近乎完全闭塞，肿瘤染色的血管造影消失。2 例患者均进行了手术切除。病例 1 的估计失血量为 600ml，病例 2 的估计失血量为 200ml。术中及术后均无需输血。栓塞后无颅神经损伤。1 例患者在切除后仍存在 House Brackman 2 级面神经麻痹。
同时进行静脉内和动脉内副神经节瘤栓塞的初步经验证明了该技术的安全性和更好的栓塞剂渗透能力。这得到了我们在栓塞过程中以及在肿瘤切除过程中的观察结果的支持。需要更多的患者接受这种技术治疗，以更好地评估长期疗效和栓塞相关颅神经病变的发生率。
