Endovascular De-vascularization of the Jugulo-tympanic ‘aggressive-Paraganglioma’
Abstract
Background: Jugulotympanic ‘aggressive-paraganglioma’ (JTa-P) grows rapidly, within months intrudes in to jugular bulb, labyrinth and compresses the lower cranial nerves (LCN). Scanty cellularity and intense-vascularity complicates tumor surgery. Post-surgically, it yields large volumes of residues and results in LCN-palsy. With increased recurrence rate it causes more morbidity and mortality.
Objective: 1. Radio-imaging early the aggressive-phenotypes. 2. De-vascularization and super-selective endovascular arterial embolization(EAE) of the tumor feeding arteries for better surgical outcome.
Material & Method: Computerized tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) characteristically defines the aggressive phenotypes. Seven patients of intractable vertigo and lower cranial nerve palsy diagnosed and devascularized between 2008 and 2012 years. JTa-P categorized as Type 1, Type 2, Type 3 and Type 4. Pre-surgically adequate de-vascularization of vascular blush-map (90%) along with EAE performed, followed by surgery between 3rd and 5th day of the de-vascularization. It gives maximum avascularity.
Results: Subtotal radical excision was possible. LCN-functions could be preserved in 42.85%. Morbidity reduced to 50%. Vertigo tinnitus improved. Four year follow up showed no tumor recurrence.
Conclusion: 1. Radio imaging gives early diagnosis. 2. Endovascular de-vascularizationis an useful adjunct in reducing morbidity and mortality.
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