CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(01): e26-e34
DOI: 10.1055/s-0041-1739270
Original Article

Preoperative Endovascular Embolization of Glomus Jugulare Tumors: A Retrospective Case Series of 22 Embolizations in 20 Patients and Literature Review

Embolização endovascular pré-operatória de tumores de glômus jugular: Uma série de casos retrospectiva de 22 embolizações em 20 pacientes e revisão da literatura
1   Department of Neurology, Neurological Institute of Curitiba, Curitiba, PR, Brazil
2   Department of Endovascular Neurosurgery and Interventional Neuroradiology, Neurological Institute of Curitiba, Curitiba, PR, Brazil
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2   Department of Endovascular Neurosurgery and Interventional Neuroradiology, Neurological Institute of Curitiba, Curitiba, PR, Brazil
3   Department of Vascular Neurosurgery, Neurological Institute of Curitiba, Curitiba, PR, Brazil
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3   Department of Vascular Neurosurgery, Neurological Institute of Curitiba, Curitiba, PR, Brazil
4   Department of Skull Base Surgery, Neurological Institute of Curitiba, Curitiba, PR, Brazil
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2   Department of Endovascular Neurosurgery and Interventional Neuroradiology, Neurological Institute of Curitiba, Curitiba, PR, Brazil
3   Department of Vascular Neurosurgery, Neurological Institute of Curitiba, Curitiba, PR, Brazil
› Author Affiliations

Abstract

Objective Glomus jugulare tumors, or tympanojugular paragangliomas, are rare, highly vascularized skull base tumors originated from paraganglion cells of the neural crest. With nonabsorbable embolic agents, embolization combined with surgery has become the norm. The authors assess the profile and outcomes of patients submitted to preoperative embolization in a Brazilian tertiary care hospital.

Methods The present study is a single-center, retrospective analysis; between January 2008 and December 2019, 22 embolizations were performed in 20 patients in a preoperative character, and their medical records were analyzed for the present case series.

Results Hearing loss was the most common symptom, present in 50% of the patients, while 40% had tinnitus, 30% had dysphagia, 25% had facial paralysis, 20% had hoarseness, and 10% had diplopia. In 7 out of 22 embolization procedures (31%) more than a single embolic agent was used; Gelfoam (Pfizer, New York, NY, USA) was used in 18 procedures (81%), in 12 of which as the single agent, followed by Embosphere (Merit Medical, South Jordan, UT, USA) (31%), Onyx (Medtronic, Minneapolis, MN, USA) (9%), and polyvynil alcohol (PVA) and Bead Block (Boston Scientific, Marlborough, MA, USA) in 4,5% each. The most common vessel involved was the ascending pharyngeal artery, involved in 90% of the patients, followed by the posterior auricular artery in 15%, the internal maxillary artery or the occipital artery in 10% each, and the superficial temporal or the lingual arteries, with 6% each. Only one patient had involvement of the internal carotid artery. No complications from embolization were recorded.

Conclusions Preoperative embolization of glomus tumors is safe and reduces surgical time and complications, due to the decrease in size and bleeding.

Resumo

Objetivo Tumores de glômus jugular, ou paragangliomas timpanojugulares, são tumores de base de crânio raros, altamente vascularizados, originados das células paragangliônicas da crista neural. Com agentes embólicos não-absorvíveis, embolização combinada com cirurgia se tornou a norma. Os autores avaliam os perfis e desfechos de pacientes submetidos a embolização pré-operatória em um hospital terciário brasileiro.

Métodos O presente estudo é uma análise retrospectiva realizada em centro único; entre janeiro de 2008 e dezembro de 2019, 22 embolizações foram realizadas em 20 pacientes em caráter pré-operatório. Seus registros médicos foram analisados para a presente série de casos.

Resultados Hipoacusia foi o sintoma mais comum, presente em 50% dos pacientes, enquanto 40% tinham tinnitus, 30% tinham disfagia, 25% tinham paralisia facial, 20% tinham rouquidão e 10% tinham diplopia. Em 7 das 22 embolizações (31%), mais de 1 agente embólico foi utilizado; Gelfoam (Pfizer, Nova York, NY, EUA) foi usado em 18 procedimentos (81%), em 12 dos quais como agente único, seguido de Embosphere (Merit Medical, South Jordan, UT, EUA) (31%), Onyx (Medtronic, Minneapolis, MN, USA) (9%), e polyvynil alcohol (PVA) e Bead Block (Boston Scientific, Marlborough, MA, EUA) (4,5% cada). Os vasos mais comumente acometidos foram a artéria faríngea ascendente (90% dos pacientes), seguida da artéria auricular posterior (15%), a artéria maxilar interna e a artéria occipital (10% cada) e as artérias temporal superficial e lingual (6% cada). Apenas um paciente teve acometimento da artéria carótida interna. Não houve complicação secundária a embolização.

Conclusão Embolização pré-operatória de glômus jugular é segura e reduz tempo e complicações cirúrgicas, pela redução em tamanho e sangramento.

Authors Contributions

Pedro MKF: manuscript research and composition


Leal AG: manuscript research and composition


Ramina R: manuscript revision


Meneses MS: manuscript revision




Publication History

Received: 09 November 2020

Accepted: 16 June 2021

Article published online:
17 December 2021

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