Introduction: Preoperative embolization of hypervascular head and neck tumors is frequently performed. Experience with Onyx has shown good results, however is limited to small case series. We report our experience on 100 consecutive tumors.

Methods: We retrospectively analyzed patients who underwent presurgical hypervascular tumors embolization using Onyx from October 2006 to December 2011. 79 patients had surgery within 48 hours after embolization and 21 only underwent palliative embolization. The patient’s demographic characteristics, tumor type and location, angiographic findings, embolization techniques, complications, intraoperative blood losses and findings were analyzed.

Results: 100 patients (63 female and 37 female; mean age was 53 years) were included. Tumors included: 39 meningiomas, 23 metastasis, 16 paragangliomas, 5 juvenile nasal angiofibromas, and 17 other types of tumors. To avoid embolization of dangerous anastomosis, angiographic analysis of the feeding arteries and their branches was performed. Embolization were performed either transarterially, by direct tumoral puncture or both. All embolizations were completed in a single session. Intraoperative blood loss (IBL) was documented in 77 patients; IBL less than 100 cc was seen in 21 (27%) patients, from 100 to 500 cc in 34 (45%) patients, from 500 to 1000 cc in 15 (20%), from 1000 to 2000 cc in 4 (5%) and more than 2000 cc in 3 (3%) patients. Complications were 3 groin hematomas, onyx extravasation around tumor in 3, and 1 transient facial palsy. Some patients who underwent only palliative embolization, decrease tumor size and symptoms improvement was seen.

Conclusions: Embolization of hypervascular neck and head tumors with Onyx is technically feasible and safe. Advantages of Onyx are: permanent embolization, deeper and more extensive penetration with less arterial catheterizations. Onyx causes tumor infarction and necrosis, making its resection easier. Embolization alone decreases tumoral size and mass effect. This could be an alternative for patients who do not undergo tumor resection.

Patient Care: Presurgical embolization of hypervascular head and neck tumors is feasible and safe. It decreases blood loos during the surgical resection, decreases the length of surgery and potential complications. Embolization with Onyx causes tumor ischemia and necrosis, reduces tumor size and mass effect. These effects potentially can decrease symptoms related to the tumor. It could be an alternative for those patients on whom surgical resection is not feasible or desirable.

Learning Objectives: Describe the importance of the liquid embolic agent Onyx in the preoperative embolization of hypervascular head and neck tumors. Describe the advantages over other embolic agents, the potential risks and complications. The role of palliative embolization of tumors that will not undergo surgical resection.

References: Gore P, Theodore N, Brasiliense L, Kim LJ, Garrett M, Nakaji P, Gonzalez LF, McDougall CG, Albuquerque FC. The utility of onyx for preoperative embolization of cranial and spinal tumors.Neurosurgery. 2008 Jun;62(6):1204-11; discussion 1211-2. Elhammady MS, Wolfe SQ, Ashour R, Farhat H, Moftakhar R, Lieber BB, Aziz-Sultan MA.Safety and efficacy of vascular tumor embolization using Onyx: is angiographic devascularization sufficient? J Neurosurg. 2010 May;112(5):1039-45. Wanke I, Jäckel MC, Goericke S, Panagiotopoulos V, Dietrich U, Forsting M. Percutaneous embolization of carotid paragangliomas using solely Onyx. AJNR Am J Neuroradiol. 2009 Sep;30(8):1594-7. Epub 2009 Apr 15. Elhammady MS, Peterson EC, Johnson JN, Aziz-Sultan MA. Preoperative Onyx Embolization of Vascular Head and Neck Tumors by Direct Puncture.World Neurosurg. 2011 Nov 10. [Epub ahead of print] Gemmete JJ, Ansari SA, McHugh J, Gandhi D. Embolization of vascular tumors of the head and neck. Neuroimaging Clin N Am. 2009 May;19(2):181-98, Table of Contents. Review.