Embolization of Carotid Body Tumors: Revisiting Direct Puncture Technique, Preliminary Experience and Literature Review

Abstract

Preoperative embolization via transarterial route is an acceptable adjunct to the treatment of carotid body tumors (CBT). Direct tumor puncture for embolization has been previously described as a safe and feasible option. We revisit this technique and present our initial experience treating CBT via direct puncture. We identified six patients that underwent preoperative embolization of CBT using a direct puncture technique embolized with Onyx (EV3 Micro Therapeutics Inc., Irvine, CA, USA). After defining the angioarchitecture via digital subtraction angiography, the tumor was targeted with Onyx. Using a 21-gauge needle, the tumor was punctured using a fluoroscopic road mask. There were no immediate post-procedural complications following embolization. All patients underwent definitive resection within 24 hours. During surgery, the embolization material did not affect surgical maneuvers. In addition, the estimated blood loss was noted to average 50 ml. Although early in our experience, direct percutaneous embolization of CBT appears to be a reproducible and well-tolerated endovascular treatment option. Overall, the reported body of evidence available confirms the safety and efficacy of direct intralesional embolization with Onyx.

Keywords: carotid body tumors; direct puncture; onyx; tumor embolization.

Figure 1. Digital subtraction angiography in AP projection revealing a vascularized carotid body lesion.

Figure 2. Unsubtracted parenchymogram of the lesion confirming needle position

Figure 3. Parenchymogram in mid-arterial phase reconfirming the appropriate location of the needle

Figure 4. Digital subtraction angiography of the common carotid artery after treatment with Onyx revealing significant reduction in vascularity with preservation of the parent arteries.

Figure 5. Post-treatment axial XPER CT detailing the Onyx mass within the tumor.