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38 - Interventional Neuroradiology in Head and Neck Oncology

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
John B. Weigele  and
Robert W. Hurst
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
John B. Weigele
Affiliation:
Assistant Professor, Division of Interventional Neuroradiology University of Pennsylvania Philadelphia, PA
Robert W. Hurst
Affiliation:
Professor of Radiology, Division of Interventional Neuroradiology University of Pennsylvania Philadelphia, PA
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
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Summary

Interventional neuroradiologic procedures are integral to the management of patients with head and neck tumors. Preoperative embolization of vascular neoplasms is used at many centers to minimize intraoperative hemorrhage and facilitate surgical resection. Also, balloon test occlusion provides a valuable preoperative assessment of an artery that may undergo surgical sacrifice. In some cases, preoperative permanent arterial occlusion facilitates radical tumor resection. In addition, endovascular techniques are critically important for the control of intractable hemorrhage due to vascular erosion from tumor or complications of therapy (carotid blowout syndrome). Finally, selective intra-arterial infusion of chemotherapeutic agents contributes to the multidisciplinary management of malignant head and neck carcinomas. The role of interventional neuroradiology in head and neck oncology promises to expand as new devices and techniques are developed.

EMBOLIZATION OF VASCULAR HEAD AND NECK TUMORS

Vascular head and neck tumors frequently are referred for preoperative embolization. Most common are juvenile nasopharyngeal angiofibromas (JNAs) and paragangliomas. Various other vascular head and neck tumors also have been embolized (1–3). Preoperative embolization is widely believed to improve surgical outcomes by decreasing surgical blood loss, minimizing operative time, and facilitating the tumor resection. Nonetheless, no level I evidence exists. Many case series have been published supporting preoperative embolization; a minority of conflicting reports concludes preoperative embolization only adds risk without significantly improving surgical morbidity and mortality (4).

Technique

Two techniques have been developed for preoperative embolization of vascular head and neck tumors: transarterial embolization with small particulates and direct-puncture embolization with liquid embolic agents (1–7).

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 483 - 497
Publisher: Cambridge University Press
Print publication year: 2008

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