Preoperative Direct Puncture Embolization Using aNonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas.

Abstract

This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using anonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP). We conducted areview of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals. Atotal of 25cases of HNPs in 24patients underwent direct puncture embolization (12males, 12females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm3. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with ahomogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type. Preoperative embolization of HNPs using adirect puncture technique and EVOHs is asafe, efficient, and feasible treatment option with alow risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.