Applications of interventional neuroradiology in the head and neck

Urgent and elective intervention in head and neck cancer patients is increasingly common. This chapter discusses techniques that are appropriate for these indications.

The aim of this study was to assess the clinical application, extent of tumour devascularization and surgical outcome after embolization of nasopharyngeal angiofibromas prior to surgery by using percutaneous cyanoacrylate glue and endovascular particulate material. We discuss our primary experience, and describe technical considerations and potential complications of the procedure.

This study reports 29 patients with juvenile nasopharyngeal angiofibromas; that were embolized prior to surgical resection with percutaneous glue and endovascular particulate material; with surgery performed 24–72 h later. Preoperative and postoperative imaging studies were reviewed. Documented intraoperative blood loss was obtained and analysed.

Almost complete radiographic devascularization was encountered in 26 of 29 tumours. An average of 3.2 spinal needles was placed in the tumours. An average of 4.2 mL of cyanoacrylate glue was injected into each tumour. The estimated mean of the blood transfused during the operations was 150 mL. The embolization procedure proved to be safe and effective with no major or serious complications.

The embolization of nasopharyngeal angiofibromas before surgery using percutaneous cyanoacrylate glue with endovascular particulate material proved to efficiently devascularize these tumours with lower blood loss during surgery and no major procedural complications.

The purpose of this study was to evaluate the effectiveness on function preservation and tumor control of the treatment of glomus tympanicum tumors with pre-operative embolization followed by total surgical resection.

We describe a series of 6 patients with a glomus tympanicum tumor who were treated in our hospital using the same technique: the day before surgery selective tumor embolization due to denaturation with 96% ethanol. Following parameters were considered: tumor classification, tumor control, clinical and audiological outcome, effectiveness of embolization, percentage of tumor necrosis and treatment complications.

There were no severe complications due to embolization or surgery. Tumor blush disappeared completely in 5 patients on DSA post embolization and histologic evaluation of the resected tissue showed a median of 69.2% of tumor necrosis. Pulsatile tinnitus disappeared in all patients and 3 patients had no symptoms at all. Hearing ameliorated in 4 patients, 1 patient without hearing loss pre- treatment still had normal hearing after treatment and 1 patient's hearing was worse after treatment. Average follow-up was 21.3 months.

Treatment of glomus tympanicum tumors by pre-operative embolization with ethanol and surgical resection has not been described before. Our results show that it is a safe procedure with a good long term tumor control, good clinical and audiological outcome.

Juvenile nasopharyngeal angiofibromas and paragangliomas are the most common hypervascular tumors of the head and neck that require embolization as an adjunct to surgery. A detailed understanding of the functional vascular anatomy of the external carotid artery is necessary for safe and effective endovascular therapy. Embolization, using a transarterial technique and particulate agents, a direct puncture technique and liquid embolic agents, or both techniques may allow for complete devascularization of hypervascular tumors of the head and neck. Effective embolization of these tumors results in a significant reduction of blood loss during surgery and allows for complete resection of the tumors. Use of meticulous technique and a thorough knowledge of functional anatomy of the head and neck vasculature are essential.