Preliminary experience with the percutaneous embolization of paragangliomas at the carotid bifurcation using only ethylene vinyl alcohol copolymer (EVOH) Onyx

Background/purpose: Carotid body paragangliomas are rare hypervascular lesions which may benefit from preoperative devascularization to reduce intraoperative blood loss. The optimal method for devascularization of these tumors is not known. Our purpose was to evaluate the extent of angiographic devascularization and intraoperative blood loss using only ethylene vinyl alcohol copolymer (EVOH) for percutaneous glomus tumor embolization. Methods: A consecutive series of seven paragangliomas located at the carotid bifurcation were treated with percutaneous embolization with EVOH as the sole embolic agent. Results: Complete devascularization of seven paragangliomas was achieved in all cases percutaneously with only EVOH. There were no complications. The average intraoperative blood loss was 55 ml (range 15-80 ml). Conclusions: Our preliminary experience suggests that EVOH may offer a higher degree of devascularization when compared with other embolic agents. This may facilitate easier surgical resection with lower blood loss. EVOH seems to be safe when percutaneously injected as the sole embolic agent.