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Título

PREOPERATIVE ENDOVASCULAR EMBOLIZATION OF GLOMUS JUGULARE TUMORS: A RETROSPECTIVE CASE SERIES OF 22 EMBOLIZATIONS IN 20 PATIENTS

Resumo

INTRODUCTION: Glomus jugulare tumors are rare, highly vascularized though slow-growing skull base tumors that originate from paraganglion cells of the neural crest. The approach for these lesions remains controversial, neurosurgeons are often faced with challenges due to the rich vascularization of the lesions as well as to the intimate relationship with neural and vascular structures. To minimize the risks for the patient and ensure total resection, a combined approach is ideal. OBJECTIVE: Evaluate the profiles and outcomes of patients submitted to preoperative jugular glomus embolization in a Brazilian tertiary care hospital. METHODS: The present study is a retrospective analysis of a series of paraganglioma embolizations between January 2008 and December 2019. The embolization was performed through super selective catheterization of feeder arteries between 3 to 5 days prior the surgical procedure; feeders from the external carotid artery and internal carotid artery were embolized with gelatin foam, polyvinyl alcohol foam, or polyvynil alcohol particles, embolic spheres, Bead Block, and ethylene-vinyl alcohol copolymer, or EVOH. The aim of the treatment was radical and complete tumor removal in one surgical procedure with preservation of the cranial nerves. RESULTS: In the period studied 22 paraganglioma embolizations were performed in 20 patients, 11 of them had already been submitted to previous neurosurgical procedures. There were 11 women and 9 men, with a mean age of 51.25 years old. All patients underwent both embolization and surgery afterwards. Hearing loss was the most common symptom (50%), while 40% of patients had tinnitus, 30% had dysphagia, 25% had facial paralysis, 20% had hoarseness, and 10% had diplopia. The most common vessel involved was the ascending pharyngeal artery (90%), followed by the posterior auricular artery (15%), the internal maxillary artery or the occipital artery (10% each), and the superficial temporal or the lingual arteries (6% each). The embolization was deemed total in 13 procedures, partial in 4 procedures, and was not reported in the remaining 5. Only one patient had involvement of the internal carotid artery. No complications from embolization were recorded. CONCLUSIONS: Glomus jugulare tumors are complex lesions that demand a multidisciplinary approach to ensure satisfactory resection with preservation of lower cranial nerves. Preoperative embolization is essential to ensure one-stage operation.