Skip to main content
SpringerLink
Log in

Combined Endovascular and Percutaneous Embolization in Management of Complex Craniofacial Tumors and Vascular Malformations: Case Reports

  • Case Report
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

Surgery of craniofacial vascular malformations and hypervascular tumors may be associated with profuse bleeding, incomplete resection, increased operative time, high rates of complications, and functional impairments. Embolization has evolved as a major adjunct to surgery, reducing bleeding and operative duration as well as offering a clean surgical field for improved resection rates. Occasionally, it can be used as the primary mode of therapy. Both liquid and particle embolic agents are used for embolization. While most embolizations are still done transarterially, the percutaneous route offers an easier and cheaper way to embolize some of the lesions and the two techniques can be combined in many of the challenging cases to offer safe and total or near-total devascularization. The authors present in this pictorial essay a series of such cases, including primary and metastatic tumors, and arteriovenous and venous malformations. Both n-butyl cyanoacrylate glue and polyvinyl alcohol particles were used with more than 90% devascularization achieved in all cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

The data is available and can be sought with the authors on request.

Code Availability

Not applicable.

References

  1. Ahmad S. Endovascular embolization of highly vascular head and neck tumors. Interdiscip Neurosurg. 2020;19:100386.

  2. Lazzaro MA, Badruddin A, Zaidat OO, Darkhabani Z, Pandya DJ, Lynch JR. Endovascular embolization of head and neck tumors. Front Neurol. 2011;2:64.

    Article  Google Scholar 

  3. Ou CH, Wong HF, Yang MS, Yang TH, Ho TL. Percutaneous direct puncture embolization for superficial craniofacial arteriovenous malformation. Interv Neuroradiol. 2008;14(2_suppl):19–22.

    Article  Google Scholar 

  4. Churojana A, Chiewwit P, Chuangsuwanich A, Aojanepong C, Chawalaparit O, Suthipongchai S. Embolization of vascular malformations in head and neck regions. A single center experience. Interv Neuroradiol. 2004;10(1):37–46.

    Article  CAS  Google Scholar 

  5. Zähringer M, Guntinas-Lichius O, Gossmann A, Wustrow J, Krüger K, Lackner K. Percutaneous embolization for cervicofacial neoplasms and hemorrhages. ORL J Otorhinolaryngol Relat Spec. 2005;67(6):348–60.

    Article  Google Scholar 

  6. Ahmad S. Cookie cutter technique for percutaneous direct puncture glue embolization of high-flow craniofacial arteriovenous malformations. Interdiscip Neurosurg. 2020;20:100677.

  7. Krishnamoorthy T, Gupta AK, Rajan JE, Thomas B. Stroke from delayed embolization of polymerized glue following percutaneous direct injection of a carotid body tumor. Korean J Radiol. 2007;8(3):249–53.

    Article  Google Scholar 

  8. Gao M, Gemmete JJ, Chaudhary N, Pandey AS, Sullivan SE, McKean EL, et al. A comparison of particulate and onyx embolization in preoperative devascularization of juvenile nasopharyngeal angiofibromas. Neuroradiology. 2013;55(9):1089–96.

    Article  Google Scholar 

  9. Borota L, Mahmoud E, Nyberg C, Ekberg T. Combined percutaneous and transarterial devascularisation of juvenile nasopharyngeal angiofibroma with protection of internal carotid artery: a modification of the technique. Interv Neuroradiol. 2015;21(3):390–6.

    Article  Google Scholar 

  10. Mazoyer. Coagulation disorders in patients with venous malformation of the limbs and trunk: a case series of 118 patients. Arch Dermatol. 2008;144(7):861–7.

    Article  Google Scholar 

  11. Ryu CW, Whang SM, Suh DC, Kim S-M, Jang Y-J, Kim H-J, et al. Percutaneous direct puncture glue embolization of high-flow craniofacial arteriovenous lesions: a new circular ring compression device with a beveled edge. AJNR Am J Neuroradiol. 2007;28(3):528–30.

    CAS  Google Scholar 

  12. Bodhey NK, Gupta AK, Purkayastha S, Kesavadas C, Krishnamoorthy T, Kapilamoorthy TR, et al. Embolization of craniofacial vascular malformations. Riv Neuroradiol. 2005;18(3):349–56.

    Article  Google Scholar 

  13. Kumar S, Bhavana K, Kumar S, Kumar P. Ultrasound-guided polidocanol foam sclerotherapy for treating venous malformations. J Clin Ultrasound. 2018;46(1):23–31.

    Article  Google Scholar 

  14. Kumar S, Bhavana K, Sinha AK, Kumar S, Prasad A, Bharti B, et al. Image-guided percutaneous injection sclerotherapy of venous malformations. SN Compr Clin Med. 2020;2:1462–90.

    Article  CAS  Google Scholar 

  15. Stein M, Guilfoyle R. The, “little AVM”: a new entity in high-flow versus low-flow vascular malformations. Plast Reconstr Surg Glob Open. 2014;2(7):e187.

    Article  Google Scholar 

  16. Ramezani A, Haghighatkhah H, Moghadasi H, Taheri MS, Parsafar H. A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma. Indian J Ophthalmol. 2010;58(5):419–21.

    Article  Google Scholar 

  17. Kumar S, Bhavana K. Angiographic correlates of blood loss in endoscopic excision of juvenile nasopharyngeal angio-fibroma. Otorhinolaryngol Head Neck Surg. 2019;4:1–5.

    Article  Google Scholar 

  18. Onerci M, Gumus K, Cil B, Eldem B. A rare complication of embolization in juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol. 2005;69(3):423–8.

    Article  Google Scholar 

  19. Elhammady MS, Johnson JN, Peterson EC, Aziz-Sultan MA. Preoperative embolization of juvenile nasopharyngeal angiofibromas: transarterial versus direct tumoral puncture. World Neurosurg. 2011;76(3–4):328–34; discussion 263-265.

    Article  Google Scholar 

  20. Thompson JN, Fierstein SB, Kohut RI. Embolization techniques in vascular tumors of the head and neck. Head Neck Surg. 1979;2(1):25–34.

    Article  CAS  Google Scholar 

  21. Wanke I, Jäckel MC, Goericke S, Panagiotopoulos V, Dietrich U, Forsting M. Percutaneous embolization of carotid paragangliomas using solely Onyx. AJNR Am J Neuroradiol. 2009;30(8):1594–7.

    Article  CAS  Google Scholar 

  22. Spiotta AM, Miranpuri AS, Vargas J, Magarick J, Turner RD, Turk AS, et al. Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions. J Neurointerv Surg. 2014;6(7):547–755.

    Article  Google Scholar 

  23. Paramasivam S, Niimi Y, Fifi J, Berenstein A. Onyx embolization using dual-lumen balloon catheter: initial experience and technical note. J Neuroradiol J Neuroradiol. 2013;40(4):294–302.

    Article  Google Scholar 

  24. George B, Casasco A, Deffrennes D, Houdart E. Intratumoral embolization of intracranial and extracranial tumors. Neurosurgery. 1994;35(4):771–4.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Subhash Kumar

  2. Department of ENT, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Kranti Bhavana

  3. Department of Ophthalmology, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Gautam Lokdarshi

  4. Department of CTVS, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Sanjeev Kumar

  5. Department of Neurosurgery, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Saraj Kumar Singh

  6. Department of Pediatric Surgery, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Bindey Kumar

  7. Department of Radiodiagnosis, Nalanda Medical College and Hospital, Patna, Bihar, 800026, India

    Pranav Kumar Santhalia

Authors
  1. Subhash Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kranti Bhavana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gautam Lokdarshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sanjeev Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saraj Kumar Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bindey Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pranav Kumar Santhalia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have contributed to the manuscript and vouch for the authenticity of the data. The detailed contributions are as follows:

Dr. Subhash Kumar

Conception and design, acquisition of data, analysis and interpretation of data

Drafting the article or revising it critically for important intellectual content

Final approval of the version to be published

Agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity

Dr. Kranti Bhavana

Acquisition of data, analysis and interpretation of data

Drafting the article or revising it critically for important intellectual content

Final approval of the version to be published

Agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity

Dr. Gautam Lokdarshi

Acquisition of data

Drafting the article or revising it critically for important intellectual content

 

Agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity

Dr. Sanjeev Kumar

Acquisition of data

 

Final approval of the version to be published

Agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity

Dr. Saraj Kumar Singh

Acquisition of data

Drafting the article or revising it critically for important intellectual content

 

Agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity

Dr. Bindey Kumar

Acquisition of data

  

Agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity

Dr. Pranav Kumar Santhalia

Conception and design, acquisition of data

 

Final approval of the version to be published

Agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity

Corresponding author

Correspondence to Subhash Kumar.

Ethics declarations

Ethical Statement

All procedures performed in 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.

Consent to Participate

All participants had provided consent for using their clinical data for research.

Consent for Publication

All participants had provided consent for using their clinical data for publication.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Imaging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, S., Bhavana, K., Lokdarshi, G. et al. Combined Endovascular and Percutaneous Embolization in Management of Complex Craniofacial Tumors and Vascular Malformations: Case Reports. SN Compr. Clin. Med. 4, 156 (2022). https://doi.org/10.1007/s42399-022-01237-7

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s42399-022-01237-7

Keywords

Search

Navigation