We report on the preoperative embolization of a carotid-body paraganglioma by temporary balloon occlusion and ethanol injection. Complete devascularization was achieved without complication. Resection after a short postembolization interval required artery sacrifice. Histologic evaluation revealed that the tumor contained diffuse ethanol-induced microemboli. Compared with unembolized and polyvinyl-alcohol-embolized carotid-body paragangliomas, our technique resulted in no greater adverse effects on the tumor-vessel interface. This procedure is an effective and promising method of preoperative embolization of carotid-body tumors and warrants further experience and study. In this article, we also review the literature on carotid-body tumor embolization and ethanol embolization.
References
1.
KepesJ.J., YardeW.L.Visualization of injected embolic material (polyvinyl alcohol) in paraffin sections with Verhoeff-Van Gieson elastica stain. Am J Surg Pathol1995; 19: 709–11.
2.
LinkD.P., StrandbergJ.D., VirmaniR.Histopathologic appearance of arterial occlusions with hydrogel and polyvinyl alcohol embolic material in domestic swine. J Vasc Interv Radiol1996; 7: 897–905.
3.
LackE.E.Tumors of the adrenal gland and extra-adrenal paraganglia. In: Atlas of Tumor Pathology. 3rd series, Fascicle 19. Washington, D.C.: Armed Forces Institute of Pathology, 1995: 321–42.
4.
NoraJ.D., HallettJ.W.Jr., O'Brien PC, et al. Surgical resection of carotid body tumors: Long-term survival, recurrence, and metastasis. Mayo Clin Proc1988; 63: 348–52.
5.
MuhmM., PolterauerP., GstottnerW.[Glomus caroticum chemodectoma: Review on current diagnosis and therapy]. Wien Klin Wochenschr2000; 112: 115–20.
6.
MarangosN., SchumacherM.[Management of large bilateral glomus jugulare tumors], HNO1999; 47: 816–20.
7.
FruhwirthJ., KochG., KleinG.E.[Preoperative angiographic embolization of carotid glomus tumors. A method for improving operability]. HNO1996; 44: 510–3.
8.
LavoldE., FrengA.B., NakstadP.[Combined embolization and surgery of paragangliomas of the glomus caroticum. Report of a case and review of literature]. Tidsskr Nor Laegeforen1996; 116: 2449–51.
9.
FengJ., LiB., ZhouD.[Preoperative embolization of paraganglioma in head and neck]. Zhonghua Wai Ke Za Zhi1995; 33: 675–6.
10.
GeorgeB., CasascoA., DeffrennesD., HoudartE.Intratumoral embolization of intracranial and extracranial tumors: Technical note. Neurosurgery1994; 35: 771–3.
11.
MurphyT.P., BrackmannD.E.Effects of preoperative embolization on glomus jugulare tumors. Laryngoscope1989; 99: 1244–7.
12.
YoungN.M., WietR.J., RussellE.J., MonsellE.M.Superselective embolization of glomus jugulare tumors. Ann Otol Rhinol Laryngol1988; 97: 613–20.
13.
IaccarinoV., SodanoA., BelfioreG.Embolization of glomus tumors of the carotid: Temporary or definitive?Cardiovasc Intervent Radiol1985; 8: 206–10.
14.
CasascoA., HerbreteauD., HoudartE.Devascularization of craniofacial tumors by percutaneous tumor puncture. AJNR Am J Neuroradiol1994; 15: 1233–9.
15.
LonserR.R., HeissJ.D., OldfieldE.H.Tumor devascularization by intratumoral ethanol injection during surgery. Technical note. J Neurosurg1998; 88: 923–4.
16.
HortonJ.A., KerberC.W.Lidocaine injection into external carotid branches: Provocative test to preserve cranial nerve function in therapeutic embolization. AJNR Am J Neuroradiol1986; 7: 105–8.
17.
LivraghiT., FestiD., MontiF.US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology1986; 161: 309–12.
18.
SolbiatiL., GiangrandeA., De PraL.Percutaneous ethanol injection of parathyroid tumors under US guidance: Treatment for secondary hyperparathyroidism. Radiology1985; 155: 607–10.
19.
ValavanisA.Preoperative embolization of the head and neck: Indications, patient selection, goals, and precautions. AJNR Am J Neuroradiol1986; 7: 943–52.
20.
TanakaK., OkazakiH., NakamuraS.Hepatocellular carcinoma: Treatment with a combination therapy of transcatheter arterial embolization and percutaneous ethanol injection. Radiology1991; 179: 713–7.
21.
EllmanB.A., ParkhillB.J., CurryT.S.III, Ablation of renal tumors with absolute ethanol: A new technique. Radiology1981; 141: 619–26.
22.
HeissJ.D., DoppmanJ.L., OldfieldE.H.Brief report: Relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol. N Engl J Med1994; 331: 508–11.
23.
LippiF., FerrariC., ManettiL.Treatment of solitary autonomous thyroid nodules by percutaneous ethanol injection: Results of an Italian multicenter study. The Multicenter Study Group. J Clin Endocrinol Metab1996; 81: 3261–4.
24.
CravenW.M., RedmondP.L., KumpeD.A.Planned delayed nephrectomy after ethanol embolization of renal carcinoma. J Urol1991; 146: 704–8.
25.
SampeiK., HashimotoN., KazekawaK.Histological changes in brain tissue and vasculature after intracarotid infusion of organic solvents in rats. Neuroradiology1996; 38: 291–4.
26.
YamakadoK., TakedaK., NishideY.Portal vein embolization with steel coils and absolute ethanol: A comparative experimental study with canine liver. Hepatology1995; 22: 1812–8.
27.
BuchtaK., SandsJ., RosenkrantzH., RocheW.D.Early mechanism of action of arterially infused alcohol U.S.P. in renal devitalization. Radiology1982; 145: 45–8.
