Angiographic evaluation and embolization of cervico-cranial tumors -- juvenile paraganglioma and angiofibroma of the nasopharynx.

Abstract

INTRODUCTION: The goal of pre-operative embolization is tumoral desvascularization, with decrease of intraoperative hemorrhage and shortening of operation time and, consequently, decrease operative morbility. The authors review their experience in angiographic evaluation and preoperative embolization of paragangliomas and juvenile nasopharyngeal angiofibroma (JNA). PATIENTS AND METHODS/RESULTS: There were reviewed the angiographic characteristics of 22 patients with paragangliomas, most of them jugular and/or tympanic, 10 of them embolized with PVA. There were angiographically evaluated 6 JNA, 5 of which were embolized with PVA. There weren't any neurological complications during the procedures, diagnostic angiography and embolization. In the cases submitted to endovascular treatment, there was a significative preoperative desvascularization rate, with subjective improving of intraoperative conditions in terms of blood loss. CONCLUSION: A detailed angiographic characterization of the tumor allows the evaluation of embolization risks, due to the presence of anastomoses or arterial feeding of important structures. Tumor preoperative embolization must be done in a restricted group of hypervascular tumors, in a multidisciplinary approach with the surgical team and must be a safe procedure, without carrying additional morbility to the surgery.