Evaluating the Potential of Preembolization Using Ethylene-Vinyl Alcohol (Onyx and Squid) in Carotid Body Tumor Paraganglioma.

Autor: Palavani LB; Faculty of Medicine, Max Planck University Center, São Paulo, Brazil. Electronic address: lucca.palavani730@al.unieduk.com.br., Camerotte R; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Pari Mitre L; Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil., Batista S; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Banderali I; Faculty of Medicine, Max Planck University Center, São Paulo, Brazil., Vilardo M; School of Medicine, Catholic University of Brasilia, Brasilia, Brazil., Vieira Nogueira B; Faculty of Medicine, Serra dos Órgãos University Center, Rio de Janeiro, Brazil., Pereira V; Department of Neurosurgery, Rio de Janeiro State University, Rio de Janeiro, Brazil., Macedo L; Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA., Bertani R; Department of Neurosurgery, University of São Paulo, São Paulo, Brazil., Rassi MS; Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil., de Oliveira JG; 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. 487-503.e4. Date of Electronic Publication: 2024 Aug 13.
DOI: 10.1016/j.wneu.2024.08.058
Abstrakt: Objective: This study aims to evaluate the efficacy and safety of preoperative embolization, used 48 hours before surgery to reduce tumor size and surgical complications in carotid body paragangliomas.
Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Cochrane Handbook. A comprehensive literature search was performed in Medline, Embase, Web of Science, and Cochrane databases. The inclusion criteria were: 1) observational studies, 2) reporting on diagnosed carotid body paragangliomas, 3) undergoing preoperative embolization procedures, and 4) with ethylene-vinyl alcohol as an embolic agent.
Results: The study analyzed 106 patients, aged 18-79, using primarily Onyx 18 for embolization, with treatment intervals ranging from 24 hours to 2 weeks. Efficacy outcomes showed near-total devascularization in 67% of cases (95% confidence interval [CI]: 0.47-0.87; I² = 74%), subtotal devascularization in 33% (95% CI: 0.12-0.54; I² = 43%), and total devascularization in 97% (95% CI: 0.88-1.00; I² = 41%), indicating significant heterogeneity across outcomes. The mean estimated blood loss was 184.46 ml (95% CI: 116.72-252.20 ml). Postembolization complication rate was exceptionally low at 1% (95% CI: 0.00-0.06; I² = 0%).
Conclusions: In conclusion, preoperative embolization of carotid body tumors achieved high rates of devascularization with minimal blood loss and a very low incidence of complications, highlighting its effectiveness and safety as a treatment strategy.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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