[Diagnosis and treatment of head and neck paragangliomas. Uses of angiography and interventional radiology].

The present article aims to describe the current role of interventional neuroradiology in the diagnosis and treatment of head and neck paragangliomas, based on our experience and a literature review. The cellular polymorphism of head and neck paragangliomas confers these tumors with their characteristics hypervascularization (angioarchitecture) with characteristic arteriographic signs and hemorrhage that justify presurgical embolization. The main indications of digital angiography in head and neck paragangliomas are to confirm diagnosis and identify functional involvement of the large cervical vessels, as well as their possible vascular replacement. Extensive carotid or jugular involvement may require excision of these vessels. Functional tests that allow the patency of the circle of Willis and/or that of the contralateral sigmoid sinus to be identified are required to predict post-treatment neurological complications. Although the treatment of choice of head and neck paragangliomas is complete excision, hypervascularization may complicate surgical resection. Presurgical embolization is used to facilitate treatment by reducing blood loss, shortening operating time and lowering postoperative neurological morbidity. Palliative embolization is indicated in patients with inoperable tumors. Currently, three interventional techniques can be used in the treatment of head and neck paragangliomas: endovascular embolization, direct percutaneous puncture, and placement of vascular stents. Although infrequent, the most severe complications are those related to embolism of the embolizing material. These complications are less frequent in highly specialized centers.