Endovascular preoperative embolization of carotid paraganglioma: A case report

TL;DR

A case report shows that preoperative embolization effectively reduces bleeding and aids in the surgical removal of a carotid paraganglioma.

Contribution

This case demonstrates the safe and effective use of endovascular embolization as a preoperative strategy for carotid body paragangliomas.

Findings

Preoperative embolization achieved 50% devascularization of the tumor without complications.

Surgical excision was completed with minimal bleeding and no transfusion needed.

Endovascular embolization is a safe adjunct that facilitates surgical dissection and reduces perioperative risks.

Abstract

Carotid body paragangliomas are highly vascular tumors of the head and neck. Surgical resection is the gold standard treatment, and preoperative embolization has been proposed to reduce intraoperative bleeding and facilitate tumor removal. We present the case of a 33-year-old woman with a rapidly enlarging left cervical mass. CT and MRI demonstrated a lesion at the carotid bifurcation with splaying of the internal and external carotid arteries ('lyre sign'), consistent with a Shamblin group III carotid body tumor. Digital subtraction angiography revealed intense tumoral blush supplied mainly by branches of the external carotid artery. Selective embolization with 400-µm Embosphere® Microspheres (Merit Medical Systems, South Jordan, UT, USA) was performed 24 hours before surgery, achieving approximately 50% devascularization without complications. Complete surgical excision was subsequently achieved with minimal intraoperative bleeding and no need for transfusion. Postoperative recovery was uneventful. Preoperative endovascular embolization is a safe and effective adjunct in the management of carotid body paragangliomas. It reduces vascularity, facilitates surgical dissection, and may decrease perioperative morbidity.

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