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AJNR - American Journal of Neuroradiology

Published ahead of print on April 15, 2009
doi: 10.3174/ajnr.A1601

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American Journal of Neuroradiology 30:1594-1597, September 2009
© 2009 American Society of Neuroradiology

HEAD AND NECK

Percutaneous Embolization of Carotid Paragangliomas Using Solely Onyx

I. Wanke^a,b, M.C. Jäckel^c, S. Goericke^a, V. Panagiotopoulos^a,d, U. Dietrich^e and M. Forsting^a

^aFrom the Institute of Diagnostic and Interventional Radiology and Neuroradiology (I.W., S.G., V.P., M.F.), University of Essen, Essen, Germany
^bDepartment of Neuroradiology (I.W.), Klinik Hirslanden, Zürich, Switzerland
^cDepartment of Oto-Rhino-Laryngology (M.C.J.), University Hospital of Essen, Essen, Germany
^dDepartments of Neurosurgery and Interventional Neuroradiology (V.P.), University of Patras, Patras, Greece
^eDepartment of Neuroradiology (U.D.), Krankenanstalten Gilead, Bielefeld, Germany.

Please address correspondence to Isabel Wanke, MD, PhD, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Hufelandstr 55, 45147 Essen, Germany; e-mail: isabel.wanke{at}uni-due.de

BACKGROUND AND PURPOSE: Paragangliomas are highly vascularized usually benign neoplasms arising from nerve tissue. Endovascular preoperative embolization is used to facilitate surgery but is often not complete, due to tiny feeding arteries not feasible for selective catheterization. Our purpose was to evaluate angiographic and clinical outcome using Onyx for percutaneous glomus tumor embolization.

MATERIALS AND METHODS: A consecutive series of 4 patients with 6 paragangliomas located at the bifurcation of the common carotid artery were treated with percutaneous embolization using Onyx as the sole embolic material.

RESULTS: Complete devascularization of the 6 paragangliomas was achieved using a percutaneous embolization technique with Onyx as a sole agent, combined with an endovascular microballoon that offered protection of the internal carotid artery.

CONCLUSIONS: Further documentation is necessary to prove the higher grade of devascularization of paragangliomas with Onyx compared with other embolic material and the associated potential to facilitate surgery. Nevertheless, Onyx seems to be safe when used percutaneously due to its lavalike pattern flow and its controllable properties, allowing slow tumor bed penetration.