Efficiency and Safety of Preoperative Embolization of Paragangliomas of The Head and Neck
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Background: Paragangliomas of the head and neck, also known as glomus tumors or chemodectomas, are rare neoplasms that account for less than 5% of all head and neck tumors, with an incidence rate ranging from 1 in 30,000 to 1 in 100,000. They can cause local compressive symptoms, leading to varied clinical presentations, or may show biochemical activity. Regardless of their location, paragangliomas are highly vascular and generally benign; however, they can be locally infiltrative, potentially lethal, and challenging to treat. The estimated malignant potential ranges from 2–8% of cases. Histologic examination of the tumor does not provide a definitive diagnosis of its malignant potential. The presence of tumor cells in lymph nodes or systemic metastases is the only accepted criterion for malignancy. Because these tumors can be locally destructive or exhibit malignant tendencies, surgical resection is usually necessary. However, their high vascularity can lead to significant bleeding during surgery, which may impede the complete surgical removal of the lesion. Thus, pre-surgical embolization is an intervention that has been shown to reduce surgical time and blood loss, thereby decreasing morbidity and mortality. The most commonly used method for embolizing these lesions is the transarterial approach, although the direct puncture technique has also been described in some cases. Results: Between January 2021 and March 2023, twenty-five patients with head and neck paraganglioma were referred to our department for preoperative embolization. All cases showed no post-embolic complications. The average intra-operative blood loss was approximately (384 ± 150.5) mL, and only one case required an intra-operative blood transfusion due to injury to the internal jugular vein during the surgical procedure. Two cases, representing 8% of the study group, could not be completely excised, with residual tumor volume that was less than 25% in both cases; one was a recurrent jugulotympanicum lesion, and the other was associated with injury to the internal jugular vein during surgical resection. Conclusion: Preoperative embolization of paragangliomas is a safe technique that can significantly enhance the surgical approach, especially when a targeted strategy is employed using the most appropriate methods and materials for each specific case.