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6 - Combined endovascular and surgery treatment for neck and head paragangliomas
Ender Uysal, Sıtkı Mert Ulusay, Şenol Civelek, Muzaffer Başak
Objective: Paragangliomas are intense vascular tumors originated from neural crest and they involve the vascular wall or spesific nerves in the head and neck region. In this study, we aim to present the experiences of the cases in which the preoperative embolisation and the surgical approach is combined for the paraganliom treatment.
Materials and methods: PVA (polivynil alcohol) particle embolisation directed to the hypervascular mass and preoperative angiography were performed in totally 12 paraganglioma cases (8 male, 4 female) referred to our clinic in 2006-2009. Bilateral carotis angiography, embolisation of tumor nidus in several degrees and then cerebral angiography (to show that Willis poligon is patent) were performed in all cases. The surgical resection was performed within 48 hours after embolisation.
Results: Carotid body paraganglioma was the most common tumor among all cases (84.6%). Glomus timpanicum was observed in one case (%8,3), and glomus jugulare was observed in other case (%8,3) Multicentrity was observed in only one case (8.3%) and the bilateral carotid body tumor was followed. There was a familial relationship in two cases (father and son). No complication was observed during and after embolisation and angiography in the cases subjected to endovascular process. The cranial nerve injury after surgical resection was developed in two cases. Cerebellar hemorrhage was observed in one case at the post-op CT assessment of the mass that involve posterior fossa.
Conclusion: The combination of the preoperative embolisation and the surgical approach is a safe, effective and acceptable treatment approach for the paragangliomas. The surgical resection combined with endovascular treatment is important to obtain complete tumor resection and decrease morbidity.
Keywords: Paragangliomas, glomus, embolization
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