PREOPERATIVE EMBOLIZATION IN THE MANAGEMENT OF NECK PARAGANGLIOMAS

Surgery of neck paragangliomas carries inherent risks of excessive blo od loss and cranial nerve injury. Preoperative embolization has been u sed to lessen the morbidity of surgery, We sought to characterize our experience with preoperative embolization by evaluating safety, effica cy, and surgical data. During a period of 22 years (1974 to 1996), 19 consecutive patients with 27 histopathologically confirmed neck paraga ngliomas were surgically treated at the Oulu University Hospital. All patients underwent preoperative arteriography and 17 patients had cerv ical ultrasonography (US). Eleven patients with 15 tumors were operate d on without embolization and nine patients with 12 tumors were preope ratively embolized with 150- to 250-mu m polyvinyl alcohol (PVA) parti cles, The mean blood loss during surgery in the nonembolized group was 1374 mL (range, 100 to 4500 mL) and the mean operation time was 4 hou rs and 48 minutes (range, 1.5 to 9 hours). In the embolized group the mean blood loss was significantly less (588 mL; range, 100 to 1800 mL; P = 0.04) and the mean operation time shorter (3 hours 24 minutes; ra nge, 2 to 5 hours; P = 0.05). No embolic complications were recorded a fter the embolization. We conclude that preoperative embolization of n eck paragangliomas 3 cm or greater in diameter with PVA particles is s afe. Embolization to minimize operative bleeding facilitates surgery, shortens the operation time, and lessens the surgical risks.