Paragangliomas Introduction

CT represents one of the main modalities to assess the invasion of the tumor into bony structures including the petrous bone, temporal bone, and bones of the head and neck.

Magnetic resonance imaging represents the best diagnostic test for paragangliomas (glomus tumors) to determine their size, vascularity is suggested by the MRI invasion into adjacent structures and other vascular areas.

Angiography represents a crucial diagnostic and therapeutic modality in the overall treatment of paragangliomas. Angiography is utilized to demonstrate the vascularity of paragangliomas, venous drainage, as well as invasion into vascular structures such as the jugular vein or the sigmoid sinus.

Embolization of paragangliomas is utilized as an important adjunct in the surgical removal of paragangliomas. The introduction of transarterial embolization in glomus tumors has revolutionized the management of this disease. At present angiography and embolization of paragangliomas is the standard of care in the preoperative treatment of this very vascular head and neck tumors.

The technical aspects of embolization of paragangliomas (glomus tumors) will depend on the location of the tumor, the anatomical distribution of the arteries involved in the supply of paragangliomas and the presence or absence of collateral circulation, blood supply to the cranial nerves as well as clinical involvement of the cranial nerves. In general, paragangliomas are embolized with particles. However, in selected cases, liquid embolic agents such as NBCA may be the best available techniques. The use of other liquid embolics is expanding. For proper embolization of glomus tumors, it is imperative that a skillful and trained team is available for the understanding of the blood supply, collateral circulation, blood supply to the cranial nerves, and the anastomosis between the arteries of outside the brain with those of inside the brain. Proper knowledge of this anatomy and appropriate technique will avoid the great majority of complications.

The complication of embolization of paraganglioma should be under 1% and it represents appropriate knowledge of collateral circulation, anastomosis or connections between the arteries of outside the brain and those inside the brain, as well as meticulous technique and skillful multidisciplinary team.

Embolization of paragangliomas (glomus tumors) is done in the majority of cases as an adjunct to surgical removal of the tumor. The main goal of the procedure is to decrease the blood supply to the tumor to permit safer and faster removal of the tumor. Embolization of paragangliomas may also make the resection more complete.

In selected occasions, embolization of paragangliomas may be utilized as a palliative treatment in large paragangliomas that cannot be removed surgically. In such cases, palliative embolization of paragangliomas is done to control the growth of the tumor, to permit relief of symptoms including pain and compression of vital structures.

Radiation of paragangliomas is an alternative in the slow growing tumors when surgery and embolization of paragangliomas cannot be done.

REFERENCE: A. Berenstein, P. Lajeunesse, K.G. Ter Brugge, Volume II-1, Page 227-264.

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