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Batista S, Palavani LB, Fim Andreão F, de Barros Oliveira L, Viviani de Abreu L, Pinheiro AC, Fontoura J, Yuri Ferreira M, Bertani R, Junior de Andrade E, Almeida Filho JA, Paiva WS. Assessing the safety and efficacy of EVOH Pre-Embolization in head and neck paraganglioma tumors: A comprehensive analysis of current literature. J Clin Neurosci 2024; 120:147-153. [PMID: 38244529 DOI: 10.1016/j.jocn.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Head and Neck Paragangliomas are characterized by having a rich blood supply. Presurgical embolization with Onyx as a neoadjuvant treatment is not a consensus regarding its efficacy and safety. Our study aimed to answer this matter through a single-arm meta-analysis. METHODS We systematically reviewed 4 databases. Sixteen studies were described and suitable papers were selected for meta-analysis of estimated intraoperative blood loss (EBL), percentage of tumor devascularization, and complications associated with embolization. RESULTS The study identified 198 patients with 203 tumors, aged between 8 and 70 years. Commonly reported symptoms included neck mass perception and cranial nerve impairment. Carotid Body Tumors were most prevalent (127, 62.5 %), followed by jugular (48, 23.6 %), or vagal (29, 14.2 %) tumors. Eight studies reported estimated intraoperative blood loss (EBL) averaging 261.89 ml (95 %CI: 128.96 to 394.81 ml). In an analysis of 9 studies, 99 % (95 %CI: 96 to 100 %) achieved 70 % or more devascularization, and 79 % (95 %CI: 58 to 100 %) achieved 90 % or more devascularization. Complications from endovascular procedures were observed in 3 % (95 %CI: 0 to 8 %) of 96 patients across 10 studies, including 4 facial nerve deficits. Eighteen postoperative neurological deficits were reported across 15 articles. CONCLUSION Despite acknowledged limitations, with refined indications, EVOH, especially Onyx embolization may significantly bolster patient safety, decreasing EBL and easing surgical resection. Further research with larger studies will refine criteria, optimize techniques, and improve patient care and treatment outcomes in the management of head and neck paragangliomas.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Agostinho C Pinheiro
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Júlia Fontoura
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
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Retroperitoneal Paraganglioma-Induced Cardiogenic Shock Rescued by Preoperative Arterial Embolization. Case Rep Crit Care 2018; 2018:4058046. [PMID: 30073095 PMCID: PMC6057417 DOI: 10.1155/2018/4058046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background Catecholamine-induced cardiogenic shock is a rare manifestation of paragangliomas. The high mortality rate of this condition makes the immediate, multidisciplinary approach mandatory. Case Report We report a case of an 18-year-old woman with a retroperitoneal secreting paraganglioma, complicated with a cardiogenic shock and an acute adrenergic myocarditis, requiring hemodynamic support and emergency arterial embolization prior to surgical excision, with a favorable outcome. Conclusion Paraganglioma-induced myocarditis is rare but can be dramatic. Management requires appropriate and immediate hemodynamic support. Embolization may be an alternative to stabilize the patient prior to surgery.
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Ghali MG, Srinivasan VM, Hanna E, DeMonte F. Overt and Subclinical Baroreflex Dysfunction After Bilateral Carotid Body Tumor Resection: Pathophysiology, Diagnosis, and Implications for Management. World Neurosurg 2017; 101:559-567. [DOI: 10.1016/j.wneu.2017.02.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022]
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de Paula Miranda E, Lopes RI, Padovani GP, Moscardi PRM, Nishimura FGM, de Mendonça BB, Carnevale FC, Cristofani LM, Duarte RJ, Srougi M, Denes FT. Malignant paraganglioma in children treated with embolization prior to surgical excision. World J Surg Oncol 2016; 14:26. [PMID: 26837305 PMCID: PMC4736257 DOI: 10.1186/s12957-016-0778-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background Paragangliomas (PGL) are rare tumors derived from neural crest cells, whose origins may vary along the chain of the sympathetic nervous system. Such tumors are often characterized by secretion of catecholamines, but sometimes they are biochemically inactive, which makes diagnosis often challenging. Malignant paraganglioma is defined by the presence of this tumor at sites where chromaffin cells are usually not found or by local invasion of the primary tumor. Recurrence, either regional or metastatic, usually occurs within 5 years of the initial complete resection but long-term recurrence is also described. Malignancy is often linked to a SDHB mutation. Preoperative embolization has been applied in the surgical management of PGLs with the objective to decrease intra-operative blood loss and surgery length without complications. Case Presentation We report two cases of patients with abdominal or pelvic malignant PGLs who have been treated surgically at our center after preoperative embolization. Surgery was a very challenging procedure with multiple surgical teams involved and embolization did not prevent major blood loss and intraoperative complications. Patients required adjuvant treatment with either chemotherapy or radiotherapy. Conclusions Many studies in the adult population have established recommendations for the diagnosis and therapeutic management of PGL, but few studies concern the pediatric population. Because malignant PGL is more important in the pediatric population, screening and early diagnosis of PGL is advisable in children with genetic predisposing. Surgical resection is the mainstay of treatment, but a multimodal approach is often required due to the complexity of cases. The role of preoperative embolization is not established and in our experience it has provided little benefit and major complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Miguel Srougi
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Zhang TH, Jiang WL, Li YL, Li B, Yamakawa T. Perioperative Approach in the Surgical Management of Carotid Body Tumors. Ann Vasc Surg 2012; 26:775-82. [DOI: 10.1016/j.avsg.2012.01.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 12/26/2011] [Accepted: 01/24/2012] [Indexed: 11/30/2022]
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Martinez JD, Zendejas B, Luna JPS, Lopez J, Luna SS, Mendoza-Sánchez F, Farley DR. Left subdiaphragmatic paraganglioma supplied by contralateral right renal artery. Int J Surg Case Rep 2012; 3:333-7. [PMID: 22561238 DOI: 10.1016/j.ijscr.2012.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/18/2012] [Accepted: 03/31/2012] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Paragangliomas are neuroendocrine tumors of the autonomic nervous system that arise from neural crest cells. Paragangliomas are typically extra-adrenal, non-functional and can be discovered incidentally, posing diagnostic and therapeutic challenges. PRESENTATION OF CASE We present the unusual case of a young man who presented with an acute abdomen secondary to small bowel obstruction, and was found to have an incidental left-sided subdiaphragmatic paraganglioma supplied by a branch of the contralateral right renal artery. DISCUSSION Emergent laparotomy revealed an internal hernia as the source of the small bowel obstruction. Initial attempts to remove an incidental left subdiaphragmatic mass were aborted because of bleeding. Subsequently, after preoperative superselective embolization of the feeding vessel arising from the right renal artery, the mass was successfully resected. Pathology was consistent with a paraganglioma. CONCLUSION This report highlights the rarity of the location and blood supply of an incidental left subdiaphragmatic paraganglioma found in the setting of a small bowel obstruction.
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Direct intratumoral embolization of intranasal vascular tumors. Auris Nasus Larynx 2012; 40:103-5. [PMID: 22341928 DOI: 10.1016/j.anl.2011.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/26/2011] [Accepted: 01/20/2012] [Indexed: 11/23/2022]
Abstract
Embolization is a well established technique that facilitates the subsequent surgical removal of vascularized tumors such as juvenile angiofibroma. Preoperative transarterial embolization has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure. Direct intratumoral embolization may help overcome this limitation. We report our experience with embolization of nasal vascular tumors by means of direct intratumoral injection of n-butyl cyanoacrylate (NBCA).
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Percutaneous Onyx Embolization of Cervical Paragangliomas. J Vasc Interv Radiol 2011; 22:1271-4. [PMID: 21856505 DOI: 10.1016/j.jvir.2011.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 06/08/2011] [Accepted: 06/15/2011] [Indexed: 11/23/2022] Open
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Ito R, Nishiike S, Tomiyama Y, Yoshii T, Yamamoto Y, Inohara H. Three Cases of Renal Cell Carcinoma Metastasizing to the Head and Neck. ACTA ACUST UNITED AC 2011; 114:864-8. [DOI: 10.3950/jibiinkoka.114.864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Li J, Wang S, Zee C, Yang J, Chen W, Zhuang W, Li X, Lv W, Huang Y, Li S. Preoperative Angiography and Transarterial Embolization in the Management of Carotid Body Tumor: A Single-Center, 10-Year Experience. Neurosurgery 2010; 67:941-8; discussion 948. [DOI: 10.1227/neu.0b013e3181eda61d] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Sixty percent of paragangliomas are located unilaterally at the carotid bifurcation. These are referred to as carotid body tumors (CBTs).
OBJECTIVE:
To present our 10-year experience in the management of patients with CBTs, and to evaluate the efficacy of angiography and preoperative embolization technique in this retrospective study.
METHODS:
Sixty-two patients with surgically removed CBTs (Shamblin class II and III), were divided into two groups. Group I, the preoperative embolization group, included 33 patients with 11 class II lesions and 25 class III lesions. Group II, the group that had surgery only, without preoperative embolization, included 29 patients with 9 class II lesions and 21 class III lesions. Comparisons were made between the groups in terms of mean intraoperative blood loss, mean operation time, mean postoperative hospital stay, and clinical complications.
RESULTS:
In group I, post-embolization angiography demonstrated complete tumor devascularization in 25 (76%) lesions and partial devascularization in 11 (24%) lesions. All but 1 (2%) lesion were completely excised. Mean intraoperative blood loss, mean operation time, and mean hospital stay were 354.8 ± 334.4 mL, 170.3 ± 75.4 min, 8.0 ± 2.1days in group I and 656.4 ± 497.4 mL, 224.6 ± 114.0 min, 9.5 ± 3.5days in group II, respectively. In group II, 27 lesions (91%) were completely removed. The transient ischemic attack (TIA) and cranial nerve injury incidence rates were 10.3% and 13.8% in group II and only 3% for TIA in group I.
CONCLUSION:
These results suggest angiography is highly valuable for the diagnosis of CBT. Preoperative selective embolization of CBT is an effective and safe adjunct for surgical resection, especially for Shamblin class II and III tumors.
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Affiliation(s)
- Jiaping Li
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chishing Zee
- Department of Neuroradiology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Jianyong Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenquan Zhuang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoxi Li
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weiming Lv
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yonghui Huang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Songqi Li
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Ozyer U, Harman A, Yildirim E, Aytekin C, Akay TH, Boyvat F. Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization. Cardiovasc Intervent Radiol 2010; 33:967-75. [DOI: 10.1007/s00270-010-9803-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 01/04/2010] [Indexed: 11/29/2022]
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Rosing JH, Jeffrey RB, Longacre TA, Greco RS. Massive extra-adrenal retroperitoneal paraganglioma: pre-operative embolization and resection. Dig Dis Sci 2009; 54:1621-4. [PMID: 19408117 DOI: 10.1007/s10620-009-0804-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Accepted: 03/24/2009] [Indexed: 12/09/2022]
Affiliation(s)
- James H Rosing
- Department of Surgery, Stanford University Medical Center, 701B Welch Road, Suite 225, Stanford, CA 94305-5784, USA.
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