Skip to main content
SpringerLink
Log in

Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications

  • Review
  • Embolisation (arterial)
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs).

Materials and Methods

A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic.

Results

This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473–799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350–624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11–32%), and vagal nerve deficits in 22% (95% CI 13–31%).

Conclusion

This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data.

Graphical Abstract

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

References

  1. Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF Jr. Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients. J Clin Endocrinol Metab. 2001;86(11):5210–6. https://doi.org/10.1210/jcem.86.11.8034.

    Article  CAS  PubMed  Google Scholar 

  2. Semaan MT, Megerian CA. Current assessment and management of glomus tumors. Curr Opin Otolaryngol Head Neck Surg. 2008;16(5):420–6. https://doi.org/10.1097/MOO.0b013e32830c4595.

    Article  PubMed  Google Scholar 

  3. Hosseinzadeh A, Rasekhi A, Borhani-Haghighi A, Asnaashari M, Abdollahifard S, Moein SA. Coil embolization of a pseudoaneurysm of the petrous internal carotid artery presenting with otorrhagia: A case report and review of the literature. Iran J Radiol. 2022;19(2):e119061. https://doi.org/10.5812/iranjradiol-119061.

    Article  Google Scholar 

  4. Tokgoz SA, et al. Glomus tumors of the head and neck: thirteen years’ institutional experience and management. Acta Otolaryngol. 2019;139(10):930–3. https://doi.org/10.1080/00016489.2019.1655588.

    Article  PubMed  Google Scholar 

  5. Devuyst L, Defreyne L, Praet M, Geukens S, Dhooge I. Treatment of glomus tympanicum tumors by preoperative embolization and total surgical resection. Am J Otolaryngol. 2016;37(6):544–51. https://doi.org/10.1016/j.amjoto.2016.08.011.

    Article  PubMed  Google Scholar 

  6. Gaynor BG, Elhammady MS, Jethanamest D, Angeli SI, Aziz-Sultan MA. Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx. J Neurosurg. 2014;120(2):377–81. https://doi.org/10.3171/2013.10.JNS13354.

    Article  PubMed  Google Scholar 

  7. Anakwenze OA, Parker WL, Schiefer TK, Inwards CY, Spinner RJ, Amadio PC. Clinical features of multiple glomus tumors. Dermatol Surg. 2008;34(7):884–90. https://doi.org/10.1111/j.1524-4725.2008.34173.x.

    Article  CAS  PubMed  Google Scholar 

  8. Saaiq M. Presentation and management outcome of glomus tumors of the hand. Arch Bone Jt Surg. 2021;9(3):312–8. https://doi.org/10.22038/abjs.2020.47878.2367.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Catapano JS, et al. Onyx embolization of skull base paragangliomas: a single-center experience. Acta Neurochir (Wien). 2020;162(4):821–9. https://doi.org/10.1007/s00701-019-04127-5.

    Article  PubMed  Google Scholar 

  10. Michelozzi C, et al. Arterial embolization with Onyx of head and neck paragangliomas. J Neurointerv Surg. 2016;8(6):626–35. https://doi.org/10.1136/neurintsurg-2014-011582.

    Article  PubMed  Google Scholar 

  11. Munn Z, Stone JC, Aromataris E, Klugar M, Sears K, Leonardi-Bee J, Barker TH. Assessing the risk of bias of quantitative analytical studies: introducing the vision for critical appraisal within JBI systematic reviews. JBI Evid Synth. 2023;21(3):467–71. https://doi.org/10.11124/jbies-22-00224.

    Article  PubMed  Google Scholar 

  12. Shi L, Lin L. The trim-and-fill method for publication bias: practical guidelines and recommendations based on a large database of meta-analyses, (in eng). Medicine (Baltimore). 2019;98(23):e15987. https://doi.org/10.1097/md.0000000000015987.

    Article  PubMed  Google Scholar 

  13. Simpson GT 2nd, Konrad HR, Takahashi M, House J. Immediate postembolization excision of glomus jugulare tumors: advantages of new combined techniques. Arch Otolaryngol. 1979;105(11):639–43. https://doi.org/10.1001/archotol.1979.00790230009002.

    Article  PubMed  Google Scholar 

  14. Helal A, et al. Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective. Interv Neuroradiol. 2022;28(2):145–51. https://doi.org/10.1177/15910199211019175.

    Article  PubMed  Google Scholar 

  15. Murphy TP, Brackmann DE. Effects of preoperative embolization on glomus jugulare tumors. Laryngoscope. 1989;99(12):1244–7. https://doi.org/10.1288/00005537-198912000-00007.

    Article  CAS  PubMed  Google Scholar 

  16. Larouere MJ, Zappia JJ, Wilner HI, Graham MD, Lundy LB. Selective embolization of glomus jugulare tumors. Skull Base Surg. 1994;4(1):21–5. https://doi.org/10.1055/s-2008-1058984.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Young NM, Wiet RJ, Russell EJ, Monsell EM. Superselective embolization of glomus jugulare tumors. Ann Otol Rhinol Laryngol. 1988;97(6 Pt 1):613–20. https://doi.org/10.1177/000348948809700607.

    Article  CAS  PubMed  Google Scholar 

  18. Jacobs JM, Shelton C, Thompson BG. Combined transarterial and transvenous embolisation of jugulotympanic paragangliomas. Interv Neuroradiol. 1998;4(3):223–30. https://doi.org/10.1177/159101999800400306.

    Article  CAS  PubMed  Google Scholar 

  19. Siedek V, Waggershauser T, Berghaus A, Matthias C. Intraoperative monitoring of intraarterial paraganglioma embolization by indocyaningreen fluorescence angiography. Eur Arch Otorhinolaryngol. 2009;266(9):1449–54. https://doi.org/10.1007/s00405-008-0879-2.

    Article  PubMed  Google Scholar 

  20. Iampreechakul P, Tirakotai W, Lertbutsayanukul P, Siriwimonmas S, Liengudom A. Pre-operative embolization of intracranial and extracranial tumors: a review of 37 cases. J Med Assoc Thai. 2016;99(Suppl 3):S91-119.

    PubMed  Google Scholar 

  21. Makiese O, Chibbaro S, Marsella M, Tran Ba Huy P, George B. Jugular foramen paragangliomas: Management, outcome and avoidance of complications in a series of 75 cases. Neurosurg Rev. 2012;35(20):185–94. https://doi.org/10.1007/s10143-011-0346-1.

    Article  PubMed  Google Scholar 

  22. Karaman E, et al. Management of jugular paragangliomas in otolaryngology practice. J Craniofac Surg. 2010;21(1):117–20. https://doi.org/10.1097/SCS.0b013e3181c466ce.

    Article  PubMed  Google Scholar 

  23. Abud DG, Mounayer C, Benndorf G, Piotin M, Spelle L, Moret J. Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas. AJNR Am J Neuroradiol. 2004;25(9):1457–62.

    PubMed  PubMed Central  Google Scholar 

  24. Rebol J. Jugular paraganglioma treatment at the UMC Maribor. 2017. https://doi.org/10.6016/ZdravVestn.2491

  25. Ladner TR, He L, Davis BJ, Yang GL, Wanna GB, Mocco J. Initial experience with dual-lumen balloon catheter injection for preoperative Onyx embolization of skull base paragangliomas. J Neurosurg. 2016;124(6):1813–9. https://doi.org/10.3171/2015.5.JNS15124.

    Article  PubMed  Google Scholar 

  26. Warren FM 3rd, McCool RR, Hunt JO, Hu N, Ng PP, Buchmann LP, Shelton C. Preoperative embolization of the inferior petrosal sinus in surgery for glomus jugulare tumors. Otol Neurotol. 2011;32(9):1538–41. https://doi.org/10.1097/MAO.0b013e318237fcf6.

    Article  PubMed  Google Scholar 

  27. White JB, Link MJ, Cloft HJ. Endovascular embolization of paragangliomas: a safe adjuvant to treatment. J Vasc Interv Neurol. 2008;1(2):37–41.

    PubMed  PubMed Central  Google Scholar 

  28. Boublata L. "Infratemporal approach with anterior transposition of facial nerve in paraganglioma surgery. Interdiscip Neurosurg. 2019. https://doi.org/10.1016/j.inat.2018.10.006.

    Article  Google Scholar 

  29. Persky MS, Setton A, Niimi Y, Hartman J, Frank D, Berenstein A. Combined endovascular and surgical treatment of head and neck paragangliomas–a team approach. Head Neck. 2002;24(5):423–31. https://doi.org/10.1002/hed.10068.

    Article  PubMed  Google Scholar 

  30. Huy PT, Kania R, Duet M, Dessard-Diana B, Mazeron JJ, Benhamed R. Evolving concepts in the management of jugular paraganglioma: a comparison of radiotherapy and surgery in 88 cases. Skull Base. 2009;19(1):83–91. https://doi.org/10.1055/s-0028-1103125.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Harati A, Deitmer T, Rohde S, Ranft A, Weber W, Schultheiss R. Microsurgical treatment of large and giant tympanojugular paragangliomas. Surg Neurol Int. 2014;5:179. https://doi.org/10.4103/2152-7806.146833.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pedro MKF. Preoperative endovascular embolization of glomus jugulare tumors: a retrospective case series of 22 embolizations in 20 patients and literature review. Arq Bras Neurocir Braz Neurosurg. 2021. https://doi.org/10.1136/neurintsurg-2014-011582.

    Article  Google Scholar 

  33. Paramasivam S. Paraganglioma—Role of preoperative evaluation and endovascular embolization. Oper Tech Otolaryngol-Head Neck Surg. 2016. https://doi.org/10.1016/j.otot.2015.12.004.

    Article  Google Scholar 

  34. De Marini P, et al. Safety and technical efficacy of pre-operative embolization of head and neck paragangliomas: A 10-year mono-centric experience and systematic review. Clin Imaging. 2021;80:292–9. https://doi.org/10.1016/j.clinimag.2021.08.014.

    Article  PubMed  Google Scholar 

  35. Moore MG, Netterville JL, Mendenhall WM, Isaacson B, Nussenbaum B. Head and neck paragangliomas: an update on evaluation and management. Otolaryngol Head Neck Surg. 2016;154(4):597–605. https://doi.org/10.1177/0194599815627667.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran

    Hossein Ghanaati, Diana Zarei, Mahbod Issaiy, Nafiseh Ghavami, Madjid Shakiba, Jayran Zebardast, Hedayat Abbastabar, Amir Hossein Jalali & Kavous Firouznia

Authors
  1. Hossein Ghanaati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diana Zarei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahbod Issaiy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nafiseh Ghavami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Madjid Shakiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jayran Zebardast
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hedayat Abbastabar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amir Hossein Jalali
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kavous Firouznia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kavous Firouznia.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study informed consent is not required.

Consent for Publication

For this type of study consent for publication is not required.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 1163 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghanaati, H., Zarei, D., Issaiy, M. et al. Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications. Cardiovasc Intervent Radiol 47, 416–431 (2024). https://doi.org/10.1007/s00270-024-03687-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-024-03687-z

Keywords

Search

Navigation