Preoperative embolisation of head and neck paragangliomas - a single-centre experience.

INTRODUCTION: Paragangliomas are neuroendocrine tumours commonly located in the abdomen, thorax, head and neck. The definitive treatment for these tumours is surgical resection, which in some cases can be very challenging due to the involvement of critical neurovascular structures and their high vascularity. Therefore, pre-operative embolisation may be performed to reduce the risk of complications. This study aimed to present our experience with endovascular embolisation of head and neck paragangliomas (HNP). MATERIAL AND METHODS: In this single-centre study, we reviewed data from consecutive patients with HNP who underwent pre-operative embolisation from 2017 to 2023. The efficacy of embolisation, the method of embolisation, as well as the rate of complications, were noted. RESULTS: A total of 27 patients (15 females) with an average age of 47 years underwent selective embolisation of HNP. Satisfactory embolisation, defined as occlusion of > 75% of the blood supply, was achieved in 22/27 cases (81.5%). The most commonly used embolic agents included coils and microspheres. With the exception of minor vessel dissections in two patients and embolic agent migration in two patients causing reversible occlusion of the intracranial vessels, there were no other complications associated with embolisation. No neurological deficits occurred in relation to the endovascular procedure. CONCLUSIONS: The results of our study indicate that endovascular embolisation of HNP prior to surgical resection is a safe and efficacious procedure, with a relatively low complication rate and associated morbidity.

Endovascular embolisation as minimally-invasive treatment for spinal dural arteriovenous fistulas - evaluation of long-term results.

AIM OF STUDY: Spinal dural arteriovenous fistulas (sDAVF) are rare spinal cord lesions formed between a radicular artery and medullary vein leading to venous hypertension resulting in neurological impairment. Endovascular embolisation is a minimally-invasive method aiming to interrupt the shunt between the artery and vein. We report our experience with sDAVF treated endovascularly. MATERIAL AND METHODS: Clinical and procedural data of 16 consecutive patients diagnosed with sDAVF was reviewed. Pre- and post-operative neurological condition was evaluated using both the Aminoff and Logue disability scale and the VAS scale. Rates of complete occlusions, technical difficulties, and procedural complications were noted. RESULTS: Four of the patients were female and 12 were male; mean age was 62.4 years. Mean interval between symptom onset and treatment was 13.3 months. Complete occlusion was achieved in 88% (14/16 patients). Significant or moderate clinical improvement in long-term follow-up was observed in eight patients (50%). Recurrence was observed in two cases (13%). CONCLUSIONS AND CLINICAL IMPLICATIONS: While endovascular methods are being refined and thus achieving an increasing percentage of successful occlusions, patients should be closely monitored since this condition is recurrent and the clinical consequences of myelopathy can persist despite complete occlusion of the shunt.

Endovascular treatment of vertebrobasilar system aneurysms - long term results.

INTRODUCTION: Microsurgical treatment of VBSA is complex and challenging due to the deep location of the vessels and the proximity of important structures. Therefore, minimally invasive endovascular techniques have been introduced to the treatment of VBSA. The aim of this study was to present long-term results and technical aspects of VBSA embolisation. In this manuscript, we describe our experience in the treatment of VBSA with long-term results. Furthermore, we discuss the advantages and disadvantages of this treatment modality, paying special attention to the technical aspects. We believe that this is an important contribution to this topic because the number of previous reports is limited. It adds to a population that can be compared to patients treated using different methods. MATERIALS AND METHODS: We analysed the medical records of patients with aneurysms of vertebral and basilar arteries referred for endovascular treatment between 2015 and 2020. RESULTS: A total of 44 patients were selected for the study. From this group, 10 patients (22.7%) were admitted with SAH caused by ruptured VBSA. The median age of the patients was 58 years (31-80), with 27 (61.4%) females and 17 (38.6%) males. The majority of the VBSAs (35, 79.5%) were located on the basilar artery. Complete occlusion was achieved in 39 patients (88.6%). Procedural complications occurred in three cases (6.8%). In long-term follow-up, complete embolisation was achieved in 81.8% (36 of 44 patients). In 18.2% (eight patients), recurrence of VBSA was observed. Two patients were qualified for recoiling. Clinical follow-up was uneventful in 37 (84%) patients. Four patients (9%) reported mild headaches. Three (7%) patients required assistance for daily living. CONCLUSIONS: Endovascular embolisation of VBSA is feasible and provides an excellent rate of complete occlusion and a high rate of favourable long-term outcomes, which support using this technique as a first-line treatment. A relatively high rate of recurrence remains the major drawback, especially in cases of wide-neck VBSA.

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer.

OBJECTIVES: Presentation of radiation-induced lesions in carotid arteries of patients with head and neck squamous cell carcinoma (HNSCC) and the evaluation of the effectiveness of endovascular treatment of symptomatic stenoses. MATERIALS AND METHODS: We retrospectively analyzed 26 patients who underwent surgery and subsequently cervical radiotherapy (RT) for HNSCC, focusing on radiation-induced vascular disease in neck arteries-from the latency period to the occurrence of neurological events-and the endovascular treatment of the internal carotid artery (ICA) and/or of common carotid artery (CCA) stenoses. The vascular lesions were diagnosed with Doppler ultrasonography and selective digital angiography. Patients with >70% stenoses of ICA and/or CCA were scheduled for carotid artery stenting (CAS). They were followed-up with neurological examinations and Doppler ultrasonography at 6, 12, and 24 months after stenting. RESULTS: Radiation-induced vascular diseases occurred in the ICA in 22 patients (85%), CCA in 15 (58%), and in ECA in 15 (58%). The stents were implanted in 25 ICA and 17 CCA. Thirteen patients (50%) had one stent, eight (30%) had two stents, four (15%) had three stents, and one patient had five stents. Overall, 46 stents were implanted. Technical success was achieved in all patients. No cerebrovascular events occurred in the 24-months follow-up. CONCLUSION: RT in patients with HNSCC holds a significant risk factor of developing carotid artery stenosis and cerebrovascular events. Carotid stenting is preferable mode of treatment for radiation-induced stenosis. A screening program with doppler ultrasonography enables pre-stroke detection of carotid stenosis.

Evaluation of effectiveness of endovascular embolisation for the treatment of pelvic congestion syndrome--preliminary study.

OBJECTIVES: The Aim: The aim of the study was to evaluate the effectiveness, safety and clinical outcomes of endovascular embolisation of pelvic congestion syndrome (PCS). MATERIAL AND METHODS: This prospective, observational study carried out between January and May of 2014 encompassed 24 female patients aged 22-44 years (average - 31 years) diagnosed with PCS. Diagnosis of PCS was established by medical history physical examination, transvaginal Doppler ultrasound examination and confirmed by MRI. The patients were qualified for phlebography and ovarian vein embolization with 0.035" detachable coils and/or microcoils. Pelvic pain scores were assessed before and 3 months after the procedure with the visual analog scale (VAS; 0 - no pain, 10 - unbearable pain). RESULTS: Embolisation procedures were performed in 23 out of 24 patients. Nineteen patients underwent unilateral and 4 patients bilateral embolisation of the ovarian vein. In one case, safe and selective vessel catheterization was not possible due to the anatomical variant of venous flow. Nineteen patients underwent unilateral embolisation of the left ovarian vein. Four patients had the left and right ovarian veins embolized; in one of them, the internal iliac vein was additionally closed (the two-stage procedure). The technical success rate was 96%. Procedures lasted 23-78 minutes (32 minutes on average). An average of 40 ml of contrast was administered during the procedures. The total mean radiation dose at the reference point was 389 mGy (from 127 mGy to 1112 mGy). A decrease in pelvic pain intensity according to VAS was considered a clinical success. The median VAS pelvic pain score before the procedure was 8. Three months after the procedure median pelvic pain score decreased to 1 (p < 0.001). In two cases, the ovarian vein was injured and the contrast medium extravasated, which was clinically insignificant. In one case, a small injection site haematoma developed. CONCLUSION: Embolisation is a minimally invasive, effective and safe method of treatment for PCS. The cooperation between gynaecologists and interventional radiologists is essential for successful outcomes.

Onyx(®) in endovascular treatment of cerebral arteriovenous malformations - a review.

Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. In most cases, the disorder may be asymptomatic. The objective of endovascular AVM treatment is set individually for each case upon consultations with a neurosurgeon and a neurologist. The endpoint of the treatment should consist in prevention of AVM bleeding in a management procedure characterized by a significantly lower risk of complications as compared to the natural history of AVM. Endovascular interventions within AVM may include curative exclusion of AVM from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Onyx was first described in the 1990s. It is a non-adhesive and radiolucent compound. Onyx-based closure of the lumen of the targeted vessel is obtained by means of precipitation. The process is enhanced peripherally to the main flux of the injected mixture. This facilitates angiographic monitoring of embolization at any stage. The degree of lumen closure is associated with the location of the vessel. Supratentorial and cortical locations are most advantageous. Dense and plexiform structure of AVM nidus as well as a low number of supplying vessels and a single superficial drainage vein are usually advantageous for Onyx administration. Unfavorable factors include nidus drainage into multiple compartments as well as multiarterial supply of the AVM, particularly from meningeal arteries, en-passant arteries or perforating feeders. Onyx appears to be a safe and efficient material for embolization of cerebral AVMs, also in cases of intracranial bleeding associated with AVM. Curative embolization of small cerebral AVMs is an efficient and safe alternative to neurosurgical and radiosurgical methods. Careful angiographic assessment of individual arteriovenous malformations should be performed before each Onyx administration.