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Gustavo G RangelHospital dos Servidores do Estado do RJEmail: otograngel@gmail.comPhone: 55 21 95442235

Evaluate the effects ofembolization using liquidembolic agent (Onyx) in surgery for jugulotympanictumors with regard to lengthof stay in hospital, duration ofprocedure, signs of facial palsy, intraoperativehemorrhage andpostoperative complications.

Application of embolization with liquid embolic agent as an adjuvant in paraganglioma surgeryG. Rangel, M. Araujo, I. Mury, L. Guimarães, D. Aquino, F. Felix

Case 4: JMS is a patient of feminine sex of 55 years admitted with a jugolotimpanic paraganglioma type C1 Fisch involving the jugular bulbwas performed embolization of the occipital artery, middle meningealand ascending pharyngeal, occurred a peripheral facial paralysis as a complication. After 5 days the patient underwent a tympanomastoidectomy with cervical extension of access for exploration of the skull base. The patient evolved without complicationsin the post operative period and was discharged in 7 days

The most commonly used embolic agent is the fast polymerizing liquidadhesive n-butyl cyanoacrylate (n-BCA). The use of n-BC requires experienceand skills, because intranidal flow and polymerization of n-BCA are quick andlargely unpredictable. Recently, a new liquid embolic agent became available: Onyx liquid embolic system. Onyx is less adhesive and polymerizes slowly, which seems advantageous over n-BCA, moreover has the same advantagesover particulate agents, these are: occlusion ofthe terminal capillaries causing a higher standard of embolization and thepossibility ofa greater range of days until surgery. Our initial experience with use of Onyx for embolization of paragangliomas is encouraging, with an average sizereduction and complete obliteration with embolization alone.

Case 1: RMFLB is 50 years patient, feminine , was admitted to theservice due to pulsatile tinnitus and hearing loss for over a year ofevolution. After the first examinations identified a tympanicparaganglioma type B Fisch, measuring approximately 2 cm andsupplied by the posterior branch of ascending pharyngealartery. Embolization was performed with 48 hours prior to surgery withcatheterization superselective of ascending pharyngeal artery andposterior auricular artery, the surgery was a tympanomastoidectomywith ossicular chain reconstruction with the incus that was involved bythe tumor, bleeding less than expected. The surgery lasted 90 minutes and had no complications, such as facial paralysis. The postoperativecourse was uneventful and the patient was discharged with 48 hours ofsurgery .

We have a shorter duration of surgery, reduced bleeding and length ofhospitalization days with a securely embolization and as a consequence lesspostoperative complications

Evaluate the effects of embolization using liquid embolic agent (Onyx) in surgery for jugulotympanic tumors with regard to length of stay in hospital, duration of procedure, signs of facial palsy, intraoperativehemorrhage and postoperative complications.

INTRODUCTION

Case 1

1. J. Bradley White ; Michael J Link ; Harry J. Clof. Endovascular embolization ofparagangliomas: A safe adjuvant to treatment. J Vasc Interv Neurol 2008; 1(2):37-412. Eugene Myers. Glomus Tumor. Operative Otolaryngology: Head and NeckSurgery, Saunders 20083. W.J. Van Roojia, M. Sluzewskia, G.N. Beuteb. Brain AVM Embolization withOnyx. AJNR Am J Neuroradiol January 2007 28: 172-1774. Murphy TP, Brackmann DE: Effects of preoperative embolization on glomusjugulare tumors. Laryngoscope 99:1244–1247, 1989

CONCLUSIONS

DISCUSSION

Case 4

REFERENCES

ABSTRACT

CONTACT

Case 6: SSA is 75 years a patient, feminine, admitted due to a hearingloss, tinnitus and otorrhea. After investigating a was identifiedjugolotimpanic paranglioma Fisch type C2, with involvement of allcervical portion of jugular e carotid, because the extent of disease andpatient age was chosen by radiotherapy alone. Performed 50 cGy for cervical and temporal field, in control with MRI seems to be no growing.

Case 6

Case 2

Case 2: LFOLF is a 57 years patient, feminine, had a large lesionemerging from the right external auditory canal with progressive growthfor 5 years but accelerated in the last year. There was no disponiblematerial for embolization and therefore was chosen a surgicaltreatment. The patient underwent a local resection of the mass, however accessing the reddish pulsatile mass we found a large volume of bleeding. There were no complications during surgery, the volume ofbleeding was excessive and the patient was released 48 hours

Case 3

Case 3: RBS is a patient of feminine sex of 62 years who presented a peripheral facial palsy grade V of House-Brackmann associated withpulsatile tinnitus. CT showed a tympanic paraganglioma type B Fisch, embolization was performed superselective of occipital, middlemeningeal and ascending pharyngeal arteries. After 48 hours thepatient underwent tympanomastoidectomy with removal of the hammerand incus, the surgery was 120 min without complications, reducedbleeding, no worsening of facial paralysis. After surgery the patientexperienced episodes of intense dizziness and needed hospital treatment for 5 days after surgery.

Case 5

Case 5: CRPL is 81 years patient, feminine, admitted with pulsatiletinnitus and hearing loss. After an investigation was identifiedjugolotimpanic paranglioma type C1 Fisch. Due to patient age waschosen to irradiation therapy alone.

1.RMFLB, blush before embolization. 2.RMFLB, arteriography after embolization

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3. JMS, aspect after embolization JMS, aspect before embolization

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4. JMS, arteriography before embolization5.JMS, arteriography after embolization