Onyx Embolization of Carotid Body Paragangliomas: An Adjunct to Safe and Effective Surgical Resection

Background: Carotid body paragangliomas are challenging lesions, embedded in a labyrinth of critical neurovascular structures. Their association with these structures can cause significant cranial nerve injury and intraoperative blood loss.

Objective: Embolization of paragangliomas may be effective at reducing intraoperative blood loss and improve the ease of surgical resection. We reviewed our experience with transfemoral transarterial Onyx embolization.

Methods: We retrospectively reviewed a database of head and neck tumors embolized at our institution. We reviewed the extent of tumor devascularization as assessed by postembolization angiography and operative blood loss.

Results: Eleven patients with 13 paragangliomas underwent preoperative embolization for 12 tumors. In five cases, we completely devascularized the tumors. In five cases, more than 90% tumor devascularization was achieved. In the remaining two cases, tumor devascularization was more than 50%. The only postprocedural complication was partial cranial nerve XII palsy. The mean surgical blood loss was 191.7 cc.

Conclusions: Carotid body tumors can be catheterized effectively through a transfemoral approach. Onyx embolization of these lesions is safe, effective, and decreases blood loss during surgical resection, aiding in the safe operative resection of these tumors.