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Preoperative Direct Puncture Embolization Using a Nonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas

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Abstract

Purpose

This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using a nonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP).

Methods

We conducted a review of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals.

Results

A total of 25 cases of HNPs in 24 patients underwent direct puncture embolization (12 males, 12 females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm3. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with a homogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type.

Conclusion

Preoperative embolization of HNPs using a direct puncture technique and EVOHs is a safe, efficient, and feasible treatment option with a low risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.

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Availability of Data and Material

Data are available upon reasonable request.

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Authors and Affiliations

  1. UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy

    Andrea M. Alexandre, Iacopo Valente, Francesco D’Argento & Alessandro Pedicelli

  2. Neuroradiology Unit, Henri Mondor Hospital, Creteil, France

    Luca Scarcia

  3. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, 47, Bd de l’Hôpital, 75013, Paris, France

    Frédéric Clarençon

  4. Sorbonne University, Paris, France

    Frédéric Clarençon

  5. Università Cattolica del Sacro Cuore, 00168, Roma, Largo Agostino Gemelli, Italy

    Arianna Camilli, Jacopo Galli, Yamume Tshomba & Alessandro Pedicelli

  6. Diagnostic and Therapeutic Neuroradiology Unit, IRCCS INM Neuromed, 86077, Isernia, Italy

    Andrea Bartolo

  7. UOC Neuroradiologia diagnostica ed interventistica, Arnas Civico Palermo, Italy

    Francesca Incandela

  8. Unit of Otorhinolaryngology, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168, Rome, Italy

    Dario Antonio Mele, Mario Rigante & Jacopo Galli

  9. Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy

    Marco Natola & Yamume Tshomba

Authors
  1. Andrea M. Alexandre
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  2. Luca Scarcia
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  4. Arianna Camilli
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  9. Marco Natola
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  14. Alessandro Pedicelli
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Corresponding author

Correspondence to Andrea M. Alexandre.

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Conflict of interest

A.M. Alexandre, L. Scarcia, F. Clarençon, A. Camilli, A. Bartolo, F. Incandela, D.A. Mele, M. Rigante, M. Natola, I. Valente, F. D’Argento, J. Galli, Y. Tshomba and A. Pedicelli declare that they have no competing interests.

Ethical standards

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study is part of a nonprofit research protocol approved by the ethics committee of the coordinating center (Fondazione Policlinico Universitario A.Gemelli IRCCS, protocol ID 3957). Informed consent was obtained from all individual participants included in our series.

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Alexandre, A.M., Scarcia, L., Clarençon, F. et al. Preoperative Direct Puncture Embolization Using a Nonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas. Clin Neuroradiol (2023). https://doi.org/10.1007/s00062-023-01364-1

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