Use of Onyx Embolization in Lateral Skull Base Surgery

Surgery of vascular skull base lesions, such as glomus jugulare tumors, is often complicated by significant blood loss. In combination with the proximity to critical neurovascular structures, such as cranial nerves, surgical resection is challenging. Preoperative embolization of feeding vessels has been employed to reduce tumor vascularity and decrease intraoperative bleeding. Onyx (ethylene vinyl alcohol copolymer) is a newer product that possesses several advantages over existing embolic agents. We describe our experience using preoperative embolization of skull base tumors with Onyx. In 2 of our cases involving large glomus jugulare lesions, no blood transfusion was needed. Thus, preoperative embolization with Onyx may reduce or eliminate the need for blood transfusion. To our knowledge, the use of this agent has not been previously reported in the neurotology/skull base literature.