AUTHOR=Kelblová Martina , Vaníček Jiří , Gál Břetislav , Rottenberg Jan , Bulik Martin , Cimflová Petra , Křivka Tomáš 

TITLE=Preoperative percutaneous Onyx embolization of carotid body paragangliomas with balloon test occlusion

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1132100

DOI=10.3389/fneur.2023.1132100

ISSN=1664-2295

ABSTRACT=Objectives: The study aims to analyze our first experience with direct percutaneous embolization of carotid body tumors (CBTs) using ethylene-vinyl alcohol copolymer (Onyx) along with balloon test occlusion (BTO).

Methods: A retrospective preliminary single-center study was conducted at the Otorhinolaryngology and Head and Neck Surgery Department and the Medical Imaging Department of the University teaching hospital (blinded for review). A consecutive series of three patients with CBTs was treated at the local institution between October 2018 and June 2019. All three patients underwent preoperative percutaneous embolization using ethylene-vinyl alcohol copolymer (Onyx 18) with the addition of BTO. Outcome measures were the percentage of tumor devascularization, peroperative blood losses, and operation times. BTO was evaluated by clinical neurological examination and neurosonological transcranial doppler examination of the middle cerebral artery (MCA). 

Results: Devascularization of all three tumors was complete or near complete. All three tumors were surgically extirpated with excellent surgical outcomes. The blood losses were minimal, and the average operation time was 2 hours and 8 minutes. BTO was positive in one patient, which was valuable additional information on carotid branches ligation limitations. The other two patients showed negative BTOs with the result of safeties of eventual carotid arteries ligations.

Conclusions: Preoperative direct percutaneous embolization of CBT with Onyx is a highly effective procedure, that significantly facilitates surgery. BTO provides valuable additional information on the most appropriate and safe surgical approach.