Direct Puncture Embolization in Skull Base Tumors: A Case Series

Background: Direct tumor embolization (DTE) is an established technique employed to reduce blood loss, operative time, and complications during resection of hypervascular head and neck tumors. Direct puncture via needle injection of Onyx™ Liquid Embolic System (Medtronic) has been safely used as an alternative to traditional intra-arterial embolization in tumors that are difficult to catheterize. There are limited reports documenting the use of DTE in resection of head and neck tumors.

Objective: To evaluate the indications, safety, and efficacy of DTE in resection of hypervascular tumors of the head and neck.

Methods: We performed a retrospective review of patients with head and neck tumors treated with DTE at our institution between 2018 and 2021.

Results: Seven patients (five female, two male) underwent intraoperative DTE prior to beginning tumor resection during the study period. Tumor pathologies included carotid body tumors (2), juvenile angiofibroma (1), venolymphatic malformations (3), and meningioma (1) ([Table 1]). We used ultrasound guidance and fluoroscopy to inject Onyx directly into the tumor ([Figs. 1]–[3]). All tumors were successfully embolized with no significant complications. Gross total resection was achieved in five of the seven tumors. There were no tumor resection complications, except for a transient cranial nerve XII palsy.

Table 1 Tumor presentation and results of direct puncture embolization surgery

Conclusion: In our series, DTE provided safe embolization for resection of hypervascular skull base tumors. Advantages of DTE may include lower risk of femoral/radial artery injury, arterial dissection, and stroke. Embolization procedure time varied greatly due to factors including surgical approach, tumor pathology, amount of embolic agent injected, and anatomic accessibility.

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Publication History

Article published online:
05 February 2024