Friend or Foe? Preoperative Embolization in Jugular Paraganglioma Surgery-A Systematic Review and Meta-Analysis.

Autor: Mitre LP; Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil. Electronic address: lucpmitre@gmail.com., Palavani LB; Max Planck University Center, São Paulo, Brazil., Batista S; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Andreão FF; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Mitre EI; Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil; Department of Otorhinolaryngology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil., de Andrade EJ; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA., Rassi MS; Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Oct; Vol. 190, pp. 22-32. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1016/j.wneu.2024.06.119
Abstrakt: Background: Jugular paragangliomas are highly vascularized tumors that can grow in challenging neurovascular compartments and are particularly challenging to resect. There is still no consensus whether preoperative embolization should be employed to minimize intraoperative morbidity.
Methods: A systematic review and meta-analysis was conducted by searching PubMed, Web of Science, and Embase databases for key terms including "embolization," "jugular paragangliomas," and "surgery."
Results: This review included 25 studies with 706 patients and 475 (67%) preoperative embolizations. Polyvinyl alcohol particles were the most common embolic agent (97.8% of all patients who underwent embolization). Complication rate of embolization was 1% (95% confidence interval [CI]: 0%, 2%). Preoperative embolization was significantly associated with less intraoperative estimated blood loss (mean difference of -7.92 dL [95% CI: -9.31 dL, -6.53 dL]), shorter operating room times (mean difference of -55.24 minutes [95% CI: -77.10 minutes, -33.39 minutes]), and less overall tumor recurrence (odds ratio = 0.23 [95% CI: 0.06, 0.91]) compared with resective surgery alone. Preoperative embolization had no impact on the development of postoperative new cranial nerve deficits not associated with embolization (odds ratio = 1.17 [95% CI: 0.47, 2.91]) and achievement of gross total resection (odds ratio = 1.92 [95% CI: 0.67, 5.53]).
Conclusions: Preoperative embolization may provide surgical efficiency with faster surgical times and less bleeding and safety with diminished overall recurrence via safe embolization with minimal risks. These results must be considered taking into account the nonrandomness of studies.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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