[Diagnosis and treatment of head and neck paragangliomas. Uses of angiography and interventional radiology]. / Diagnóstico y control evolutivo de los paragangliomas de cabeza y cuello. Interés de la angiografía y procedimientos neurorradiológicos intervencionistas.

The present article aims to describe the current role of interventional neuroradiology in the diagnosis and treatment of head and neck paragangliomas, based on our experience and a literature review. The cellular polymorphism of head and neck paragangliomas confers these tumors with their characteristics hypervascularization (angioarchitecture) with characteristic arteriographic signs and hemorrhage that justify presurgical embolization. The main indications of digital angiography in head and neck paragangliomas are to confirm diagnosis and identify functional involvement of the large cervical vessels, as well as their possible vascular replacement. Extensive carotid or jugular involvement may require excision of these vessels. Functional tests that allow the patency of the circle of Willis and/or that of the contralateral sigmoid sinus to be identified are required to predict post-treatment neurological complications. Although the treatment of choice of head and neck paragangliomas is complete excision, hypervascularization may complicate surgical resection. Presurgical embolization is used to facilitate treatment by reducing blood loss, shortening operating time and lowering postoperative neurological morbidity. Palliative embolization is indicated in patients with inoperable tumors. Currently, three interventional techniques can be used in the treatment of head and neck paragangliomas: endovascular embolization, direct percutaneous puncture, and placement of vascular stents. Although infrequent, the most severe complications are those related to embolism of the embolizing material. These complications are less frequent in highly specialized centers.

Diagnóstico y control evolutivo de los paragangliomas de cabeza y cuello. Interés de la angiografía y procedimientos neurorradiológicos intervencionistas / Diagnosis and treatment of head and neck paragangliomas. Uses of angiography and interventional radiology

El propósito de nuestro estudio es presentar, basándonos en nuestra experiencia y la revisión de la bibliografía realizada, el papel actual de la neurorradiología vascular-intervencionista en el diagnóstico y tratamiento de los paragangliomas de cabeza y cuello (PgCC). El polimorfismo celular de los PgCC les confiere su característica “hipervascularización”(angio arquitectura) con signos arteriográficos patognomónicos y un carácter hemorrágico que justifica su embolización prequirúrgica. Las indicaciones fundamentales de la angiografía digital en los PgCC se establecen para confirmar su diagnóstico y comprender la afectación funcional de los grandes vasos cervicales, así como sus posibles suplencias vasculares. La extensa afectación carotídea o yugular puede hacer inevitable el sacrificio quirúrgico de estos vasos. Son necesarias pruebas funcionales que permitan conocer la permeabilidad del polígono de Willis y/o del seno sigmoide o contralateral para predecir complicaciones neurológicas postratamiento. Aunque el tratamiento de elección de los PgCC es su exéresis completa, la hipervascularización puede hacer complicada la resección quirúrgica. La embolización prequirúrgica es utilizada para facilitar el tratamiento reduciendo la pérdida de sangre, acortando el tiempo quirúrgico y disminuyendo la morbilidad neurológica posquirúrgica. La indicación paliativa de la embolización se establece en casos de tumores inoperables. En la actualidad, se dispone de3 técnicas intervencionistas utilizables en el tratamiento de los PgCC: la embolización endovascular, la punción percutánea directa y la colocación de endoprótesis vasculares. Aunque poco frecuentes, las complicaciones más graves son las relacionadas con el embolismo del material embolizante y, lógicamente, disminuyen en centros sanitarios de alto nivel y con una técnica arteriográfica depurada (AU)

The present article aims to describe the current role of interventional neuroradiology in the diagnosis and treatment of head and neck paragangliomas, based on our experience and a literature review. The cellular polymorphism of head and neck paragangliomas confers these tumors with their characteristics “hypervascularization”(angio architecture) with characteristic arteriographicsigns and hemorrhage that justify presurgical embolization. The main indications of digital angiography in head and neck paragangliomas are to confirm diagnosis and identify functional involvement of the large cervical vessels, as well as their possible vascular replacement. Extensive carotid or jugular involvement may require excision of these vessels. Functional tests that allow the patency of the circle of Willis and/or that of the contralateral sigmoid sinus to be identified are required to predict post-treatment neurological complications. Although the treatment of choice of head and neck paragangliomas is complete excision, hypervascularization may complicate surgical resection. Presurgical embolization is used to facilitate treatment by reducing blood loss, shortening operating time and lowering postoperative neurological morbidity. Palliative embolization is indicated in patients with inoperable tumors. Currently, three interventional techniques can be used in the treatment of head and neck paragangliomas: endovascular embolization, direct percutaneous puncture, and placement of vascular stents. Although infrequent, the most severe complications are those related to embolism of the embolizing material. These complications are less frequent in highly specialized centers (AU)