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<meta name="DC.Title" content="Usefulness of Percutaneously Injected Ethylene-Vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlation with Surgical Observations" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1936" />
<meta name="DC.Date" content="2010-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss.

MATERIALS AND METHODS: We retrospectively studied 14 patients (3 females and 11 males; mean age, 33.4 years; range, 11–56 years) with 15 hypervascular tumors of the head and neck that underwent direct percutaneous embolization with Onyx in conjunction with particulate embolization. Nine paragangliomas and 6 JNAs underwent treatment. Documented blood loss was obtained from operative reports in these 15 patients with surgical resection performed 24–48 hours after the embolization.

RESULTS: Intratumoral penetration with progressive blood flow stasis was achieved during each injection. A mean of 3.1 needles (20-gauge, 3.5-inch spinal needle) were placed percutaneously into the lesion (range, 1–6). The mean intraoperative blood loss was 780 mL (range, &lt;50–2200 mL). Near total angiographic devascularization was achieved in 13 of 15 tumors. There were no local complications or neurologic deficits from the percutaneous access or embolization of these hypervascular tumors.

CONCLUSIONS: In this study, the use of percutaneous injected Onyx in conjunction with standard endovascular embolization techniques in patients with hypervascular head and neck tumors seemed to enhance the ability to devascularize these tumors before operative removal.

%AVM
:   arteriovenous malformation
CBT
:   carotid body tumor
CTA
:   CT angiography
DMSO
:   dimethyl sulfoxide
DPE
:   direct percutaneous embolization
DSA
:   digital subtraction angiography
EBL
:   estimated blood loss
ECA
:   external carotid artery
EEG
:   electroencephalogram
EVOH
:   ethylene-vinyl alcohol copolymer
ICA
:   internal carotid artery
JNA
:   juvenile angiofibroma
JUG
:   jugular
LCCA
:   left common carotid artery
MIP
:   maximum intensity projection
n -BCA
:   n -butyl cyanoacrylate
PARA
:   paraganglioma
PVA
:   polyvinyl alcohol
RCCA
:   right common carotid artery
VA
:   vertebral artery
VM
:   vascular malformation" />
<meta name="DC.Contributor" content="J.J. Gemmete" />
<meta name="DC.Contributor" content="N. Chaudhary" />
<meta name="DC.Contributor" content="A. Pandey" />
<meta name="DC.Contributor" content="D. Gandhi" />
<meta name="DC.Contributor" content="S.E. Sullivan" />
<meta name="DC.Contributor" content="L.J. Marentette" />
<meta name="DC.Contributor" content="D.B. Chepeha" />
<meta name="DC.Contributor" content="S.A. Ansari" />
<meta name="article:published_time" content="2010-05-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Usefulness of Percutaneously Injected Ethylene-Vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlation with Surgical Observations" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively studied 14 patients (3 females and 11 males; mean age, 33.4 years; range, 11–56 years) with 15 hypervascular tumors of the head and neck that underwent direct percutaneous embolization with Onyx in conjunction with particulate embolization. Nine paragangliomas and 6 JNAs underwent treatment. Documented blood loss was obtained from operative reports in these 15 patients with surgical resection performed 24–48 hours after the embolization.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Intratumoral penetration with progressive blood flow stasis was achieved during each injection. A mean of 3.1 needles (20-gauge, 3.5-inch spinal needle) were placed percutaneously into the lesion (range, 1–6). The mean intraoperative blood loss was 780 mL (range, &amp;lt;50–2200 mL). Near total angiographic devascularization was achieved in 13 of 15 tumors. There were no local complications or neurologic deficits from the percutaneous access or embolization of these hypervascular tumors.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In this study, the use of percutaneous injected Onyx in conjunction with standard endovascular embolization techniques in patients with hypervascular head and neck tumors seemed to enhance the ability to devascularize these tumors before operative removal.&lt;/p&gt;" />
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<meta name="twitter:title" content="Usefulness of Percutaneously Injected Ethylene-Vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlation with Surgical Observations" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss.

MATERIALS AND METHODS: We retrospectively studied 14 patients (3 females and 11 males; mean age, 33.4 years; range, 11–56 years) with 15 hypervascular tumors of the head and neck that underwent direct percutaneous embolization with Onyx in conjunction with particulate embolization. Nine paragangliomas and 6 JNAs underwent treatment. Documented blood loss was obtained from operative reports in these 15 patients with surgical resection performed 24–48 hours after the embolization.

RESULTS: Intratumoral penetration with progressive blood flow stasis was achieved during each injection. A mean of 3.1 needles (20-gauge, 3.5-inch spinal needle) were placed percutaneously into the lesion (range, 1–6). The mean intraoperative blood loss was 780 mL (range, &lt;50–2200 mL). Near total angiographic devascularization was achieved in 13 of 15 tumors. There were no local complications or neurologic deficits from the percutaneous access or embolization of these hypervascular tumors.

CONCLUSIONS: In this study, the use of percutaneous injected Onyx in conjunction with standard endovascular embolization techniques in patients with hypervascular head and neck tumors seemed to enhance the ability to devascularize these tumors before operative removal.

%AVM
:   arteriovenous malformation
CBT
:   carotid body tumor
CTA
:   CT angiography
DMSO
:   dimethyl sulfoxide
DPE
:   direct percutaneous embolization
DSA
:   digital subtraction angiography
EBL
:   estimated blood loss
ECA
:   external carotid artery
EEG
:   electroencephalogram
EVOH
:   ethylene-vinyl alcohol copolymer
ICA
:   internal carotid artery
JNA
:   juvenile angiofibroma
JUG
:   jugular
LCCA
:   left common carotid artery
MIP
:   maximum intensity projection
n -BCA
:   n -butyl cyanoacrylate
PARA
:   paraganglioma
PVA
:   polyvinyl alcohol
RCCA
:   right common carotid artery
VA
:   vertebral artery
VM
:   vascular malformation" />
<meta name="og-title" property="og:title" content="Usefulness of Percutaneously Injected Ethylene-Vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlation with Surgical Observations" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/5/961" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss.

MATERIALS AND METHODS: We retrospectively studied 14 patients (3 females and 11 males; mean age, 33.4 years; range, 11–56 years) with 15 hypervascular tumors of the head and neck that underwent direct percutaneous embolization with Onyx in conjunction with particulate embolization. Nine paragangliomas and 6 JNAs underwent treatment. Documented blood loss was obtained from operative reports in these 15 patients with surgical resection performed 24–48 hours after the embolization.

RESULTS: Intratumoral penetration with progressive blood flow stasis was achieved during each injection. A mean of 3.1 needles (20-gauge, 3.5-inch spinal needle) were placed percutaneously into the lesion (range, 1–6). The mean intraoperative blood loss was 780 mL (range, &lt;50–2200 mL). Near total angiographic devascularization was achieved in 13 of 15 tumors. There were no local complications or neurologic deficits from the percutaneous access or embolization of these hypervascular tumors.

CONCLUSIONS: In this study, the use of percutaneous injected Onyx in conjunction with standard endovascular embolization techniques in patients with hypervascular head and neck tumors seemed to enhance the ability to devascularize these tumors before operative removal.

%AVM
:   arteriovenous malformation
CBT
:   carotid body tumor
CTA
:   CT angiography
DMSO
:   dimethyl sulfoxide
DPE
:   direct percutaneous embolization
DSA
:   digital subtraction angiography
EBL
:   estimated blood loss
ECA
:   external carotid artery
EEG
:   electroencephalogram
EVOH
:   ethylene-vinyl alcohol copolymer
ICA
:   internal carotid artery
JNA
:   juvenile angiofibroma
JUG
:   jugular
LCCA
:   left common carotid artery
MIP
:   maximum intensity projection
n -BCA
:   n -butyl cyanoacrylate
PARA
:   paraganglioma
PVA
:   polyvinyl alcohol
RCCA
:   right common carotid artery
VA
:   vertebral artery
VM
:   vascular malformation" />
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    <title>Usefulness of Percutaneously Injected Ethylene-Vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlat… | American Journal of Neuroradiology</title>  
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      <h1 class="highwire-cite-title" id="page-title">Usefulness of Percutaneously Injected Ethylene-Vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlation with Surgical Observations</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.J. Gemmete</span>, <span class="highwire-citation-author" data-delta="1">N. Chaudhary</span>, <span class="highwire-citation-author" data-delta="2">A. Pandey</span>, <span class="highwire-citation-author" data-delta="3">D. Gandhi</span>, <span class="highwire-citation-author" data-delta="4">S.E. Sullivan</span>, <span class="highwire-citation-author" data-delta="5">L.J. Marentette</span>, <span class="highwire-citation-author" data-delta="6">D.B. Chepeha</span> and <span class="highwire-citation-author" data-delta="7">S.A. Ansari</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">961-966; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1936 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9866--6334815798" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.J. Gemmete </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.J.%2BGemmete%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gemmete%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.J.%2BGemmete%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">N. 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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> We retrospectively studied 14 patients (3 females and 11 males; mean age, 33.4 years; range, 11–56 years) with 15 hypervascular tumors of the head and neck that underwent direct percutaneous embolization with Onyx in conjunction with particulate embolization. Nine paragangliomas and 6 JNAs underwent treatment. Documented blood loss was obtained from operative reports in these 15 patients with surgical resection performed 24–48 hours after the embolization.</p>
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<p id="p-3"><strong>RESULTS:</strong> Intratumoral penetration with progressive blood flow stasis was achieved during each injection. A mean of 3.1 needles (20-gauge, 3.5-inch spinal needle) were placed percutaneously into the lesion (range, 1–6). The mean intraoperative blood loss was 780 mL (range, &lt;50–2200 mL). Near total angiographic devascularization was achieved in 13 of 15 tumors. There were no local complications or neurologic deficits from the percutaneous access or embolization of these hypervascular tumors.</p>
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<p id="p-4"><strong>CONCLUSIONS:</strong> In this study, the use of percutaneous injected Onyx in conjunction with standard endovascular embolization techniques in patients with hypervascular head and neck tumors seemed to enhance the ability to devascularize these tumors before operative removal.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">%AVM<span class="def-item-dt-sep"></span></dt><dd>arteriovenous malformation<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CBT<span class="def-item-dt-sep"></span></dt><dd>carotid body tumor<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CTA<span class="def-item-dt-sep"></span></dt><dd>CT angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">DMSO<span class="def-item-dt-sep"></span></dt><dd>dimethyl sulfoxide<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">DPE<span class="def-item-dt-sep"></span></dt><dd>direct percutaneous embolization<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">DSA<span class="def-item-dt-sep"></span></dt><dd>digital subtraction angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">EBL<span class="def-item-dt-sep"></span></dt><dd>estimated blood loss<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">ECA<span class="def-item-dt-sep"></span></dt><dd>external carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">EEG<span class="def-item-dt-sep"></span></dt><dd>electroencephalogram<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">EVOH<span class="def-item-dt-sep"></span></dt><dd>ethylene-vinyl alcohol copolymer<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">JNA<span class="def-item-dt-sep"></span></dt><dd>juvenile angiofibroma<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">JUG<span class="def-item-dt-sep"></span></dt><dd>jugular<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">LCCA<span class="def-item-dt-sep"></span></dt><dd>left common carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">MIP<span class="def-item-dt-sep"></span></dt><dd>maximum intensity projection<span class="def-item-dd-sep"></span></dd><dt id="def-item-16"><em>n</em>-BCA<span class="def-item-dt-sep"></span></dt><dd><em>n</em>-butyl cyanoacrylate<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">PARA<span class="def-item-dt-sep"></span></dt><dd>paraganglioma<span class="def-item-dd-sep"></span></dd><dt id="def-item-18">PVA<span class="def-item-dt-sep"></span></dt><dd>polyvinyl alcohol<span class="def-item-dd-sep"></span></dd><dt id="def-item-19">RCCA<span class="def-item-dt-sep"></span></dt><dd>right common carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-20">VA<span class="def-item-dt-sep"></span></dt><dd>vertebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-21">VM<span class="def-item-dt-sep"></span></dt><dd>vascular malformation</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/5/961.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.J.</span> <span class="nlm-surname">Gemmete</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Chaudhary</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Pandey</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Gandhi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.E.</span> <span class="nlm-surname">Sullivan</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">L.J.</span> <span class="nlm-surname">Marentette</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Chepeha</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">961-966; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1936 </span></div>
  
  
  
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      <div class="highwire-cite-title">Usefulness of Percutaneously Injected Ethylene-Vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlation with Surgical Observations</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.J.</span> <span class="nlm-surname">Gemmete</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Chaudhary</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Pandey</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Gandhi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.E.</span> <span class="nlm-surname">Sullivan</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">L.J.</span> <span class="nlm-surname">Marentette</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Chepeha</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">961-966; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1936 </span></div>
  
  
  
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