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Onyx embolization of skull base paragangliomas: a single-center experience

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Abstract

Background

Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx.

Methods

We retrospectively analyzed data from all patients with skull base paragangliomas who underwent preoperative Onyx embolization at our institution (January 01, 2005–December 31, 2017). Patient, tumor, embolization, and outcomes data were extracted by reviewing inpatient and outpatient clinical and imaging records.

Results

Seven patients were studied (5/7 [71%] female), 6 with glomus jugulares and 1 with a glomus vagale. The median age was 52 years, and the most common presenting symptom was cranial neuropathy (6/7 [86%]). The tumor vascular supply was from the ascending pharyngeal artery in all 7 cases (100%) with additional feeders including the occipital artery in 5 (71%); internal carotid artery in 3 (43%); middle meningeal, vertebral, and internal maxillary artery each in 2 (29%); and posterior auricular artery in 1 (14%). The median postembolization tumor devascularization was 80% (range, 64–95%). The only postembolization complication was a facial palsy in 1 patient.

Conclusion

Preoperative embolization with Onyx affords excellent devascularization for the majority of skull base paragangliomas, and it may facilitate resection of these hypervascular lesions. The advantages provided by Onyx with respect to penetration of intratumoral vessels must be weighed against the risk of cranial neuropathy.

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Fig. 1

Abbreviations

EBL:

Estimated blood loss

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Acknowledgments

The authors thank the Neuroscience Publications staff at Barrow Neurological Institute for the help with manuscript preparation.

Author information

Correspondence to Felipe C. Albuquerque.

Ethics declarations

Conflict of interest

Dr. Ducruet is a consultant for Penumbra, Medtronic, and Cerenovus. The other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board of St. Joseph’s Hospital and Medical Center for Human Research (Phoenix, AZ, USA) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Tumor - Glioma

Electronic supplementary material

ESM 1

Literature Review. A literature review was performed to analyze the functional outcomes of patients who had skull base paragangliomas treated with Onyx (Medtronic, Dublin Republic of Ireland) embolization during adjunct therapy. PubMed was queried using the following parameters: (“paraganglioma” AND “embolization”) AND (“vagal” OR “tympanic” OR “jugulotympanic” OR “glossopharyngeal” OR “skull base”). Only articles published between July 21, 2005, and June 1, 2018, were searched as Onyx was first approved by the US Food and Drug Administration in July 2005 [40]. The articles were reviewed and included if they met the following selection criteria: paragangliomas were located at the skull base, adjunctive embolization was performed with Onyx, and articles were written in English. Articles were excluded if they reported using an embolization agent other than Onyx or if they omitted the method of embolization. All carotid body tumors were excluded. (PDF 397 kb)

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Catapano, J.S., Almefty, R.O., Ding, D. et al. Onyx embolization of skull base paragangliomas: a single-center experience. Acta Neurochir (2020) doi:10.1007/s00701-019-04127-5

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Keywords

  • Embolization
  • Endovascular procedures
  • Glomus tumors
  • Onyx
  • Skull base paragangliomas