Aldo Paolucci1, Anna Maria Ierardi2, Sophia Hohenstatt3, Viviana Grassi4, Silvia Romagnoli4, Lorenzo Pignataro5,6, Santi Trimarchi4,6, Gianpaolo Carrafiello1,7. 1. Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. 2. Radiology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. annamaria.ierardi@policlinico.mi.it. 3. Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany. 4. Vascular Surgery-Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy. 5. Otolaryngology Department Fondazione, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 6. Department of Clinical and Community Sciences, University of Milan School of Medicine, Milan, Italy. 7. Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy.
Abstract
PURPOSE: Different embolization techniques and materials are available for the pre-operative embolization of carotid body paragangliomas. In this study, we report the first experience of the direct percutaneous puncture technique under fluoroscopic guidance using the low-viscosity formula of SQUID-12. The additional use of a transitory balloon-blockage at the origin of the external carotid artery aims to confer higher protection by limiting the risk of non-target embolization and subsequent neurological sequelae. MATERIALS AND METHODS: We retrospectively reviewed all cases of carotid body paragangliomas that have undergone pre-surgical embolization with a direct puncture technique and balloon-assistance at our institution between 2019 and 2020. The use of the liquid EVOH-based SQUID-12 as the sole embolic agent was the main inclusion criteria. RESULTS: A total of 9 patients with 9 carotid body paragangliomas were enrolled in this case series. The mean volume of the lesion was 309 mm3. The mean embolization-session time amounted to 88 min. The average number of needles inserted was 2, and the mean volume of SQUID-12 used per case was 23 ml. Successful total devascularization was obtained in all cases. No long-term sequelae due to the embolization procedure occurred. CONCLUSIONS: Pre-operative paraganglioma embolization with SQUID-12 using a direct puncture and balloon-assisted technique is a safe and efficient method with few complications.
PURPOSE: Different embolization techniques and materials are available for the pre-operative embolization of carotid body paragangliomas. In this study, we report the first experience of the direct percutaneous puncture technique under fluoroscopic guidance using the low-viscosity formula of SQUID-12. The additional use of a transitory balloon-blockage at the origin of the external carotid artery aims to confer higher protection by limiting the risk of non-target embolization and subsequent neurological sequelae. MATERIALS AND METHODS: We retrospectively reviewed all cases of carotid body paragangliomas that have undergone pre-surgical embolization with a direct puncture technique and balloon-assistance at our institution between 2019 and 2020. The use of the liquid EVOH-based SQUID-12 as the sole embolic agent was the main inclusion criteria. RESULTS: A total of 9 patients with 9 carotid body paragangliomas were enrolled in this case series. The mean volume of the lesion was 309 mm3. The mean embolization-session time amounted to 88 min. The average number of needles inserted was 2, and the mean volume of SQUID-12 used per case was 23 ml. Successful total devascularization was obtained in all cases. No long-term sequelae due to the embolization procedure occurred. CONCLUSIONS: Pre-operative paraganglioma embolization with SQUID-12 using a direct puncture and balloon-assisted technique is a safe and efficient method with few complications.
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