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1.
Abud DG Mounayer C Benndorf G Piotin M Spelle L Moret J 《AJNR. American journal of neuroradiology》2004,25(9):1457-1462
BACKGROUND AND PURPOSE: Substantial intraoperative bleeding during surgical removal of head and neck paragangliomas may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial approach has proved beneficial but is often limited by complex vascular anatomy and unfavorable locations. We report our experience with the preoperative devascularization of head and neck paragangliomas by using direct puncture and an intralesional injection of cyanoacrylate. METHODS: We retrospectively analyzed nine consecutive patients with head and neck paragangliomas who were referred for preoperative devascularization. Three patients were treated for carotid-body tumors; two for vagal lesions; and four, for jugular paragangliomas. Direct puncture of the lesion was performed by using roadmap fluoroscopic guidance. Acrylic glue was injected by using continuous biplane fluoroscopy. All patients underwent postembolization control angiography and immediate postoperative CT scanning. RESULTS: Angiograms showed that complete devascularization was achieved in all cervical glomus tumors, whereas subtotal devascularization was achieved in jugular paragangliomas. In this latter location, the injection of acrylic glue was limited by the potential risk of reflux into normal brain territory via feeders from the internal carotid or vertebral artery. The tumors were surgically removed and histologically examined. No technical or clinical complications related to the embolization procedure occurred. CONCLUSION: Percutaneous puncture of paragangliomas in the head and neck region and their preoperative devascularization by intralesional injection of acrylic glue is a feasible, safe, and effective technique. 相似文献
2.
Umut Ozyer Ali Harman Erkan Yildirim Cuneyt Aytekin Tankut Hakki Akay Fatih Boyvat 《Cardiovascular and interventional radiology》2010,33(5):967-975
Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for
decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and
arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral
injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32–82 years who were referred for preoperative embolization of seven
carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily
performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases
with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic
guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete
or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with
primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed
regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial
approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization
procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative
devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas
with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization. 相似文献
3.
Embolization of cranial/spinal tumours and vascular malformations with hydrogel microspheres. An experience of 69 cases 总被引:3,自引:0,他引:3
Phadke R Venkatesh SK Kumar S Tandon V Pandey R Tyagi I Jain VK Chhabra DK 《Acta radiologica (Stockholm, Sweden : 1987)》2002,43(1):15-20
Objective: To evaluate polymethyl methacrylate hydrogel microspheres (HMs) as an embolization material in the management of hypervascular craniofacial and spinal lesions.Material and Methods: Sixty-nine patients with vascular lesions of the craniofacial and spinal regions underwent embolization with HM. The pathologies included craniofacial tumours (n=38), cranial arteriovenous malformations (AVMs) (n=7), dural AVM (n=1), cavernous carotid fistula (n=1), spinal tumours (n=7), spinal AVMs (n=6), orbital lesions (n=4) and scalp AVMs (n=5). Surgery was done in 56 patients. The blood loss at surgery, tumour shrinkage, surgical cleavage and ease of removal of tumour was noted from the records. Histopathology was available in 39 patients. A follow-up of 3 months to 6 years was available in 13 patients in whom embolization was the sole treatment. Surgical and histopathological findings were correlated with angio-embolization findings.Results: HMs were easy to inject through the microcatheter with good control. Good devascularization was obtained in 61 patients and partial in 8 patients. Two patients developed complications due to presence of anastomoses between intra- and extracranial circulation and 1 patient due to tumor swelling. Histopathology showed presence of HMs in all the lesions, with minimal inflammatory reaction in 2 patients. Patients with spinal lesions treated with embolization only stabilised in neurologic deficits.Conclusion: HMs are highly suitable as embolization agents in the management of craniofacial and spinal hypervascular lesions. 相似文献
4.
Tran Chi Cuong Le Minh Thang Nguyen-Luu Giang Nguyen Anh Trung Luu Vinh Qui Tran-Thi Thanh Tha Nguyen-Dao Nhat Huy Tran-Van Lam Duong-Hoang Linh Nguyen Minh Duc 《Radiology Case Reports》2023,18(3):766
Head and neck arteriovenous malformations are rare, congenital, and high-flow vascular malformations characterized by abnormal communication between feeding arteries and draining veins without intervening capillaries. Arteriovenous malformations are considered the most dangerous type of vascular malformation because progressive symptoms and infiltration can result in potentially life-threatening consequences. Left untreated, arteriovenous malformations can cause significant cosmetic deformities, severe bleeding, and high-output cardiac failure associated with arteriovenous shunting. The effective treatment of arteriovenous malformations located in the head and neck region is quite challenging due to high rates of recurrence and potentially lethal complications. We describe a case presenting with large arteriovenous malformations in the face and neck. Despite attempting several treatments, including external carotid artery ligation and embolization with liquid embolic agents, the patient continued to experience recurrence and symptoms of bleeding and pain. After admission, reconstructive plastic surgery was performed, supplemented by percutaneous direct puncture embolization, using glue injected into the venous and transarterial embolization. The patient was discharged with clinical recovery. Digital subtraction angiography remains the gold standard for assessing symptomatic and aggressive arteriovenous malformations, both before and after treatment. The treatment of head and neck arteriovenous malformations often requires a multidisciplinary approach to achieve the best clinical results. 相似文献
5.
A Casasco D Herbreteau E Houdart B George P Tran Ba Huy D Deffresne J J Merland 《AJNR. American journal of neuroradiology》1994,15(7):1233
PURPOSETo present and evaluate a devascularization technique for hypervascular tumors of the head and neck by direct tumor puncture.METHODSTumor puncture was performed percutaneously or via natural orifices (nose and mouth). In one case, an intrasellar tumor was embolized via a transseptosphenoidal surgical approach. The embolization material used was NBCA, lipiodol, and tungsten in the majority of tumors (14 out of 17) and alcohol for 3 metastases of the calvarium. We used this technique to embolize 10 nasopharyngeal fibromas, 4 tumors of the calvarium (3 metastases and 1 hemangiopericytoma), 1 intrasellar hemangiopericytoma, and 2 glomus tumors. Reflux of blood was obtained in every case after direct puncture of the tumor. Direct injection of contrast agent into the tumor revealed local parenchymography followed by local and regional venous drainage without extravasation.RESULTSTotal devascularization was obtained in 14 cases, and devascularization greater than 90% was obtained in 3 cases. Thirteen tumors were totally resected without requiring blood transfusion. During surgery, the limits of the exsanguinated tumor were very well defined in every case by the black staining induced by tungsten. Of the 4 tumors embolized but not operated on (3 metastases and 1 glomus tumor), 2 metastases needed retreatment after 6 and 8 months of remission, respectively. The other metastasis is still in remission after 3 months, and the volume of the glomus tumor decreased by 80% remains unchanged after 8 months.CONCLUSIONThis technique was initially used to devascularize tumors with difficult or dangerous intravascular access, but in view of the hemodynamic and surgical results obtained, we believe that the indications for this technique can be extended to hypervascular tumors accessible to conventional embolization. 相似文献
6.
Bapuraj JR Ojili V Singh SK Prasad GR Khandelwal N Suri S 《Australasian radiology》2006,50(2):179-182
Leiomyoma of the vagina is a very rare tumour of the lower urogenital tract. These slow-growing masses may be asymptomatic or present with pain, dyspareunia or urinary symptoms. Rarely, these tumours may present with life-threatening haemorrhage. These hypervascular tumours are treated by surgical excision. Preoperative embolization therefore may aid in devascularization of these tumours before surgical excision. We present the MRI features of a case of vaginal leiomyoma, which was managed by preoperative embolization and was then excised in toto. To the best of our knowledge, this is the first report where preoperative embolization was performed before excision of a vaginal leiomyoma with minimal peroperative blood loss. 相似文献
7.
Direct percutaneous needle puncture (DPNP) for presurgical devascularization of head and neck as well as skull base tumours is an established, yet not widespread method. We present a case of a large and highly vascularized metastasis with partial destruction of the first two cervical vertebrae and encasement of the spinal cord that was successfully treated by DPNP for preoperative devascularization after an attempted endovascular embolization had failed. The lesion was safely and effectively devascularized, which facilitated the surgical removal. The case presented illustrates the technique and furthermore demonstrates its value. 相似文献
8.
Sooho Bae Young Soo Do Sung Wook Shin Kwang Bo Park Dong-Ik Kim Young Wook Kim Sung Ki Cho Sung Wook Choo In Wook Choo 《Korean journal of radiology》2008,9(2):148-154
OBJECTIVE: We retrospectively assessed the results of performing ethanol embolization for pelvis arteriovenous malformations (AVMs). MATERIALS AND METHODS: During the past 10 years, eight patients (8 females, age range: 27-52 years) with AVMs in the pelvic wall (n = 3) and uterus (n = 5) underwent staged ethanol embolizations (range: 1-5, mean: 2.5) under general anesthesia. Ethanol embolization was performed by the use of the transcatheter and/or direct puncture techniques. Clinical follow-up was performed for all of the patients, and imaging follow-up was available for seven patients. The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography. RESULTS: During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. For two patients, the transarterial and transvenous or direct puncture approaches were used together in one session. For four patients, ethanol and coils were used as embolic agents, and n-butyl cyanoacrylate (NBCA) and ethanol were used in one patient. Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement. Major complications were seen in two patients (25%). CONCLUSION: Ethanol embolization is effective for the treatment of pelvic arteriovenous malformations, though there is a chance of a major complication. 相似文献
9.
局部穿刺栓塞治疗头颈部高血流病变 总被引:7,自引:1,他引:6
目的 总结局部穿刺栓塞治疗头颈部高血流病变的经验。方法 11例头颈部高血流病变(8例颌骨中心性血管瘤,3例鼻咽纤维血管瘤)进行了局部穿刺栓塞治疗。数字减影颈动脉造影在Philips V3000下完成。颌骨中心性血管瘤采用的栓塞材料为附纤毛的螺形圈,鼻咽纤维血管瘤采用的栓塞材料为组织胶(N-butyl-2-cyanoacrylate,NBCA)。穿刺针为14G和长7号注射针。结果 颌骨中心性血管瘤急性出血的患者经局部穿刺栓塞圈栓塞,有效控制了出血。随访9~24个月后,未发现有口腔内渗血或出血,随访X线平片可见螺形圈周围成骨。3例鼻咽纤维血管瘤局部穿刺栓塞后行手术治疗,手术中未行输血,完整摘除肿瘤。结论 局部穿刺栓塞治疗头颈部高血流病变是1种有效、安全的治疗方法。 相似文献
10.
《Journal of vascular and interventional radiology : JVIR》2022,33(1):42-48.e4
PurposeTo evaluate the safety and efficacy of ethanol embolization of lip arteriovenous malformations (AVMs).Materials and MethodsSeventy-six patients with lip AVMs were treated with 173 ethanol embolization procedures. Lip AVMs were treated with direct puncture alone in 21 patients (35 procedures, 20.2%), transarterial embolization alone in 13 patients (18 procedures, 10.4 %), and a combination of both in 60 patients (120 procedures, 69.3%). Adjunctive surgical resection was performed after embolization for cosmetic purposes based on the patient’s request, including patient preference, functional impairment, and skin necrosis. The mean duration of follow-up was 30.9 months ± 27.6. The follow-up included clinic visits and telephonic questionnaires to evaluate the clinical signs and symptoms of AVMs as well as quality of life measures.ResultsOf 76 patients, 51 showed 100% devascularization of AVMs, as determined using arteriography, followed by 23 with 76%–99% devascularization and 2 with 50%–75% devascularization. Of the 76 patients, 40 achieved complete symptom relief and 25 achieved major improvements in cosmetic deformity after embolization. Additionally, 54 patients achieved satisfactory function and aesthetic improvement with ethanol embolotherapy alone, whereas 22 achieved similar outcomes with a combination of ethanol embolotherapy and surgical intervention. Thirty-three adverse events (including 1 major) were documented.ConclusionsEthanol embolization of lip AVMs, as a mainstay, is efficacious in managing these lesions, with acceptable complications. Surgical resection after embolization may improve function and cosmesis in a subset of patients. 相似文献
11.
Preoperative transarterial embolization of spinal tumor: embolization techniques and results 总被引:6,自引:0,他引:6
Shi HB Suh DC Lee HK Lim SM Kim DH Choi CG Lee CS Rhim SC 《AJNR. American journal of neuroradiology》1999,20(10):2009-2015
BACKGROUND AND PURPOSE: The techniques of preoperative embolization of hypervascular spinal tumors, which has been known to be helpful for completing tumor resection, have not been described in detail. The purpose of this study was to analyze the technique and to evaluate the safety and value of preoperative transarterial embolization of hypervascular spinal tumors. METHODS: Eighteen patients with hypervascular spinal tumors underwent transarterial embolization before surgery. The lesions were located between the upper cervical and lower lumbar spine: C1-T1 (n = 6), T5-L3 (n = 11), and L5 (n = 1); they arose intradurally in six patients and extradurally in 12. Thirty-one arteries were embolized with polyvinyl alcohol (PVA) particles (150-500 microm), and, in 18 of these, pieces of gelatin sponge were added for proximal pedicular embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery. RESULTS: Tumor embolization was total in eight patients, nearly total in seven, subtotal in one, and partial in two. There were no symptomatic complications associated with embolization. Tumors were totally removed in 17 patients and nearly totally removed in one. The average estimated blood loss during surgery was 1100 mL (range, 200-6000 mL) for all 18 patients, and 1540 mL in patients with extradural tumors. CONCLUSION: Preoperative embolization of hypervascular spinal tumors is safe and effective. It can make complete resection of a tumor possible and can make an unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications. 相似文献
12.
J Abramowitz J E Dion M E Jensen M Lones G R Duckwiler F Vi?uela J R Bentson 《AJNR. American journal of neuroradiology》1991,12(5):977-984
Schwannomas are tumors derived from nerve sheath cells, which are often located in the head and neck, including the CNS. Although a definitive vascular pattern has been previously characterized for these lesions, preoperative embolization of the more vascular schwannomas has not been described. In a review of eight patients with schwannomas who underwent angiography at our institution since 1987, a characteristic vascular pattern became apparent that helped distinguish these lesions from other lesions of the head and neck. The lesions were moderately vascular with tortuous tumor vessels. Scattered, small puddles of contrast medium seen in the mid-arterial, capillary, and venous phases were believed to be characteristic of these lesions. Multiple feeding vessels were noted in all but one case, but these were only minimally enlarged. No arteriovenous shunting or vascular encasement was identified. Six of eight lesions were embolized with significant devascularization and no morbidity or mortality. In patients with head and neck tumors whose angiographic findings include a pattern of moderate hypervascularity, tortuous tumor vessels, and, in particular, scattered contrast puddles without arteriovenous shunting or vascular encasement, schwannoma should be suspected. Embolization is a useful and safe presurgical adjunct in the treatment of vascular schwannomas. 相似文献
13.
《Radiologia》2016,58(3):235-238
This case presentation is about an 88 years-old male patient with previous endovascular aortic aneurysm repairment history and aortic endoleak type II (EL2). The direct lumbar artery catheterization was considered an alternative to solve EL2, associated with aortic endovascular prosthesis and due to an incomplete sealing or exclusion of the aneurysmal sac or a vascular segment demonstrated by imaging studies, when other treatment alternative failed (transarterial embolization) to control the aneurysm growing. Performing translumbar approach was decided by puncturing the artery lumbar (L4) left, previously the lumbar arteries (L4) were evaluated in the abdominal CT arterial phase to guide a puncture/access under flouroscopy control. Diagnostic angiogram clearly demonstrated the median sacral and right lumbar arteries inflow into the aneurysm sac. Transcatheter embolization with fibered platinum microcoils was performed of the median sacral artery and lumbar left and right arteries (L4), showing satisfactory endoleak devascularization. 相似文献
14.
Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions 总被引:1,自引:0,他引:1
A Valavanis 《AJNR. American journal of neuroradiology》1986,7(5):943-952
Preoperative embolization was performed in 39 patients with 44 paragangliomas of the head and neck. Because of their complex vascular supply and their relation to vital structures such as the internal carotid artery and the lower cranial nerves, paragangliomas of the temporal bone represent challenging lesions to both the neuroradiologist and the otoneurosurgeon. Detailed classification by high-resolution CT and recognition of the multi- or monocompartmental vascular composition and of dangerous situations by selective angiography are essential prerequisites for safe and effective devascularization of paragangliomas of the temporal bone. Major complications that may occur if embolic material reaches intraaxial vessels through anastomoses between external carotid artery branches and the internal carotid and/or the vertebral artery can be avoided with the use of specific precautionary techniques. Palsies of the facial and lower cranial nerves can also be avoided if reabsorbable material is used for embolization of vessels supplying cranial nerves in asymptomatic patients. In selected cases with significant supply from the internal carotid artery, special interventional techniques, including embolization of the pericarotid tumor portion through the caroticotympanic artery and pre- or peroperative balloon occlusion of the petrous internal carotid artery, allow radical removal of extensive paragangliomas of the temporal bone. Techniques and selection of materials for embolization of carotid body, vagal body, and other paragangliomas of the head and neck mainly depend on the vascular composition of the tumor and on the specific vascular territory in which the tumor is located. In this series, preoperative embolization significantly improved surgical conditions of paragangliomas of any location in the head and neck and proved to represent an essential prerequisite for successful surgery of extensive paragangliomas of the temporal bone. 相似文献
15.
The classification, clinical presentation, natural history and imaging appearances of vascular masses of the head and neck are reviewed. The radiological appearances of congenital vascular masses (infantile haemangiomas and other congenital vascular tumours, high-flow and low-flow vascular malformations), acquired vascular masses (benign and malignant tumours, non-neoplastic lesions) and other hypervascular masses are described and illustrated, together with consideration of image-guided interventions. 相似文献
16.
Transfemoral venous embolization of vein of Galen malformations 总被引:3,自引:0,他引:3
C F Dowd V V Halbach S L Barnwell R T Higashida M S Edwards G B Hieshima 《AJNR. American journal of neuroradiology》1990,11(4):643-648
Three infants with vein of Galen malformations, all presenting with congestive heart failure, underwent a total of five embolization procedures that employed a percutaneous transfemoral venous approach to catheterize the vein of Galen. In one instance, direct retrograde catheterization of feeding arterial pedicles to the vein of Galen and embolization of the fistulous connections was achieved via this route. The indications for transfemoral venous treatment included persistent symptoms despite transarterial and transtorcular embolization in one patient, an unsuccessful transarterial embolization attempt (complicated by catheter fracture) in another, and the inadvisability of transarterial embolization because of an excessive number of feeding arteries in a third. Complete obliteration of the malformation was achieved in one patient and significant flow reduction in the other two. Vein of Galen perforation with the catheter tip complicated one procedure. All three patients were stable after clinical follow-ups (9-12 months). The transvenous route to the vein of Galen can be undertaken from a transfemoral approach, obviating surgical exposure of the torcular Herophili. In addition, we introduce the concept of direct retrograde catheterization of the feeding arteries to the vein of Galen malformation by a transfemoral venous approach, a procedure that has not been reported previously. 相似文献
17.
Transarterial embolization as a therapeutic option for focal nodular hyperplasia in four patients 总被引:12,自引:0,他引:12
The purpose of this study was to evaluate the potential of transarterial embolization (TAE) for the treatment of focal nodular
hyperplasia (FNH). Four women with the diagnosis of FNH underwent superselective transarterial embolization with contour particles
between 2001 and 2004. The indications were progressive increase in size in three of the patients and abdominal pain in the
fourth patient. No immediate or delayed postembolization complications were encountered in any of our patients. All patients
presented angiographically with characteristic findings, such as feeding artery, a tumor blush, and septations. In two patients,
the embolization resulted in a constant size or volume decrease in the 1-year follow-up. In the other two patients, a complete
resolution of the FNH was observed in the MRI follow-up after 1 year. This group presented with a homogeneous devascularization
in the immediate postembolization exam. In conclusion, transarterial embolization of focal nodular hyperplasia can be considered
as a possible alternative treatment method to surgery. 相似文献
18.
Guglielmi detachable coil embolization for ruptured lower-midbasilar trunk aneurysms – a report of five cases 总被引:1,自引:1,他引:0
Detachable coil embolization currently plays an essential role for patients with ruptured basilar artery aneurysms, even
though it may have an unfavorable outcome and there may be some technical problems of embolization. We describe Guglielmi
detachable coil (GDC) embolization for five ruptured lower-mid basilar trunk aneurysms, using a variety of techniques. The
patients' ages ranged from 61 to 78 years; Hunt and Kosnik grade was distributed from 2 to 4, and three patients were found
to have fenestrations of the lower basilar arteries. All patients underwent aneurysmal embolization at the subacute or chronic
stage. The transfemoral route was used in three patients – one of whom, with a wide-necked aneurysm, was treated by the balloon
remodeling technique. The transbrachial approach was chosen for the fourth patient, while vertebral artery origin exposure
followed by a direct puncture was achieved in the fifth. All patients were assessed with 80–100 % aneurysmal obliteration.
No patient re-bled after the embolization. Small cerebellar infarction, possibly due to embolism from the obliterated aneurysmal
sac, occurred 11 days after the treatment. Of the five patients, four achieved a good recovery, and one became severely disabled.
Ruptured basilar trunk aneurysms can be successfully treated with GDC embolization. In addition to the routine transfemoral
route, the transbrachial route, direct vertebral artery puncture, and balloon remodeling technique are also useful for the
embolization of this location of aneurysm.
Received: 16 November 2000/Accepted: 13 March 2001 相似文献
19.
Barth MM Khwaja K Faintuch S Rabkin D 《Journal of vascular and interventional radiology : JVIR》2008,19(8):1231-1235
Arteriovenous fistula (AVF) is a rare but well-documented complication of pancreatic allotransplantation. Small, tortuous vessels in the head of the transplanted pancreas may complicate transarterial embolization. The authors recently encountered two women who developed clinical pancreatitis after right pelvic transplant placement with documented AVF in the head of the transplanted pancreas. In the first patient, embolization was successfully performed transarterially. In the second patient, transarterial embolization was not feasible due to the small caliber and extreme tortuosity of the pancreaticoduodenal arcade and transvenous embolic occlusion was successfully performed. Both patients recovered with normalization of enzyme levels and pain reduction. 相似文献
20.
Heye S Vaninbroukx J Daenens K Houthoofd S Maleux G 《Cardiovascular and interventional radiology》2012,35(4):807-814