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Transfemoral Transarterial Onyx Embolization of Carotid Body Paragangliomas: Technical Considerations, Results, and Strategies for Complication Avoidance

Kalani, M. Yashar S. MD, PhD; Ducruet, Andrew F. MD; Crowley, R. Webster MD; Spetzler, Robert F. MD; McDougall, Cameron G. MD; Albuquerque, Felipe C. MD

doi: 10.1227/NEU.0b013e3182752d75
Research-Human-Clinical Studies

BACKGROUND: The association of carotid body paragangliomas with neurovascular structures can cause cranial nerve injury and significant intraoperative blood loss. Preoperative embolization may be performed either percutaneously or transarterially.

OBJECTIVE: We reviewed our experience with transfemoral transarterial Onyx embolization.

METHODS: We retrospectively reviewed a prospectively maintained database of head and neck tumors embolized between November 2007 and February 2012. Patients were assessed for number of sessions of embolization, number of pedicles embolized, fluoroscopic time, extent of tumor devascularization as assessed by postembolization angiography, and operative blood loss.

RESULTS: Eleven patients (5 men, 6 women; mean age, 48.1 years) with 13 paragangliomas (5 right-sided, 9 left-sided, 2 bilateral) underwent preoperative embolization for 12 tumors. Onyx alone was used in 9 cases. In a mean of 1.2 embolization sessions (range, 1-2), an average of 2.8 pedicles (range, 1-7) was embolized. The average fluoroscopic time was 54.3 minutes. In 5 cases, the tumors were completely devascularized by using this strategy. In 5 cases, more than 90% tumor devascularization was achieved. In the remaining 2 cases, tumor devascularization was more than 50%. A partial cranial nerve XII palsy was the only postprocedural complication. The mean surgical blood loss was 191.7 mL (range, 25-600 mL).

CONCLUSION: The arterial supply to carotid body tumors can be catheterized effectively through a transfemoral approach, permitting embolization of feeding pedicles. Transarterial Onyx embolization of these lesions is safe and effective, and it decreases blood loss during surgical resection.

ABBREVIATIONS: CTA, computed tomographic angiography

ECA, external carotid artery

ICA, internal carotid artery

nBCA, n-butyl cyanoacrylate

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Correspondence: Felipe C. Albuquerque, MD, c/o Neuroscience Publications; Barrow Neurological Institute, 350 W Thomas Rd, Phoenix, AZ 85013. E-mail:

Received May 11, 2012

Accepted September 05, 2012

Copyright © by the Congress of Neurological Surgeons