Assessing Pre-embolization in Carotid Body Paraganglioma Tumors: A Systematic Review and Meta-Analysis

Introduction: Paragangliomas are highly vascular tumors that originate from extra-adrenal autonomic paraganglia, commonly found in the neck and head region. Over 85% of these tumors are sporadic carotid body tumors (CBTs), which can be difficult to diagnose as they often mimic conditions like cervical lymphadenopathy. Advanced stages of CBTs can impact cranial nerves, leading to symptoms such as difficulty swallowing and hoarseness.

Objective: This study aims to assess the effectiveness and safety of pre-operative embolization performed 48 hours before surgery to reduce the size of carotid body paragangliomas and minimize surgical complications.

Materials and Methods: A systematic review and meta-analysis were performed in accordance with PRISMA guidelines and the Cochrane Handbook. A thorough literature search was conducted across Medline, Embase, Web of Science, and Cochrane databases. The inclusion criteria were as follows: (1) observational studies, (2) reporting on diagnosed carotid body paragangliomas, (3) involving preoperative embolization procedures, and (4) using EVOH as the embolic agent.

Results: The analysis included data from 106 patients aged 18 to 79 years. Onyx 18 was the primary embolic agent used, with treatment intervals ranging from 24 hours to two weeks. The outcomes showed near-total devascularization in 67% of cases (95% CI: 0.47–0.87; I ² = 74%), subtotal devascularization in 33% (95% CI: 0.12–0.54; I ² = 43%), and total devascularization in 97% (95% CI: 0.88–1.00; I ² = 41%), indicating significant heterogeneity in results. The average estimated blood loss was 184.46 ml (95% CI: 116.72–252.20 mL). The post-embolization complication rate was remarkably low at 1% (95% CI: 0.00–0.06; I ² = 0%).

Conclusion: Preoperative embolization of CBTs results in high rates of devascularization, minimal blood loss, and a very low complication rate, demonstrating its effectiveness and safety as a treatment approach.

Publication History

Article published online:
07 February 2025