Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol

Brian C. Gartrell, Marlan R. Hansen, Bruce J. Gantz, Michael B. Gluth, Sarah E. Mowry, Beverly L. Aagaard-Kienitz, Mustafa K. Baskaya, Samuel P. Gubbels

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

OBJECTIVE: To report 3 unique cases of cranial neuropathy after super-selective arterial embolization of jugular foramen vascular tumors with ethylene vinyl alcohol. STUDY DESIGN: Clinical capsule report. SETTING: Three tertiary academic referral hospitals. PATIENTS: Three patients who underwent superselective arterial embolization (SSE) of head and neck paragangliomas with ethylene vinyl alcohol are described. One individual was treated with primary SSE, whereas the remaining tumors were treated with preoperative SSE followed by surgical extirpation within 72 hours. All patients were found to have new cranial nerve deficits after SSE. RESULTS: One patient with isolated complete cranial nerve VII palsy demonstrated partial return of function at 8 months. One individual experienced cranial nerve VII, X, and XII palsies and demonstrated partial recovery of function of the involved facial nerve after 19 months. One subject experienced ipsilateral cranial nerve X and XI palsies after SSE and recovered full function of the spinal accessory nerve within 1 week but failed to demonstrate mobility of the ipsilateral true vocal fold. CONCLUSION: We present the first report documenting facial and lower cranial neuropathies after super-selective embolization of head and neck paragangliomas with EVA. Although it is difficult to draw conclusions from this small number of cases, it is plausible that the use of ethylene vinyl alcohol during SSE may result in a higher risk of permanent cranial neuropathy than the use of other well-established and more temporary agents. Knowledge of the arterial supply to the cranial nerves can help the clinician to choose the embolization agent that will provide maximal occlusion while minimizing the risk of complications.

Original languageEnglish (US)
Pages (from-to)1270-1275
Number of pages6
JournalOtology and Neurotology
Volume33
Issue number7
DOIs
StatePublished - Sep 1 2012

Fingerprint

Cranial Nerve Diseases
Facial Nerve
Neck
Alcohols
Accessory Nerve
Paraganglioma
Vagus Nerve
Cranial Nerves
Paralysis
Extravehicular Activity
Head
Hypoglossal Nerve
Vocal Cords
Recovery of Function
Tertiary Care Centers
Capsules
Blood Vessels
Neoplasms
ethylene

Keywords

  • Carotid body tumor
  • Cranial neuropathy
  • Ethylene vinyl alcohol
  • Glomus jugulare
  • Super-selective embolization

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Cite this

Gartrell, B. C., Hansen, M. R., Gantz, B. J., Gluth, M. B., Mowry, S. E., Aagaard-Kienitz, B. L., ... Gubbels, S. P. (2012). Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol. Otology and Neurotology, 33(7), 1270-1275. https://doi.org/10.1097/MAO.0b013e31825f2365

Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol. / Gartrell, Brian C.; Hansen, Marlan R.; Gantz, Bruce J.; Gluth, Michael B.; Mowry, Sarah E.; Aagaard-Kienitz, Beverly L.; Baskaya, Mustafa K.; Gubbels, Samuel P.

In: Otology and Neurotology, Vol. 33, No. 7, 01.09.2012, p. 1270-1275.

Research output: Contribution to journalArticle

Gartrell, BC, Hansen, MR, Gantz, BJ, Gluth, MB, Mowry, SE, Aagaard-Kienitz, BL, Baskaya, MK & Gubbels, SP 2012, 'Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol', Otology and Neurotology, vol. 33, no. 7, pp. 1270-1275. https://doi.org/10.1097/MAO.0b013e31825f2365
Gartrell, Brian C. ; Hansen, Marlan R. ; Gantz, Bruce J. ; Gluth, Michael B. ; Mowry, Sarah E. ; Aagaard-Kienitz, Beverly L. ; Baskaya, Mustafa K. ; Gubbels, Samuel P. / Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol. In: Otology and Neurotology. 2012 ; Vol. 33, No. 7. pp. 1270-1275.
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abstract = "OBJECTIVE: To report 3 unique cases of cranial neuropathy after super-selective arterial embolization of jugular foramen vascular tumors with ethylene vinyl alcohol. STUDY DESIGN: Clinical capsule report. SETTING: Three tertiary academic referral hospitals. PATIENTS: Three patients who underwent superselective arterial embolization (SSE) of head and neck paragangliomas with ethylene vinyl alcohol are described. One individual was treated with primary SSE, whereas the remaining tumors were treated with preoperative SSE followed by surgical extirpation within 72 hours. All patients were found to have new cranial nerve deficits after SSE. RESULTS: One patient with isolated complete cranial nerve VII palsy demonstrated partial return of function at 8 months. One individual experienced cranial nerve VII, X, and XII palsies and demonstrated partial recovery of function of the involved facial nerve after 19 months. One subject experienced ipsilateral cranial nerve X and XI palsies after SSE and recovered full function of the spinal accessory nerve within 1 week but failed to demonstrate mobility of the ipsilateral true vocal fold. CONCLUSION: We present the first report documenting facial and lower cranial neuropathies after super-selective embolization of head and neck paragangliomas with EVA. Although it is difficult to draw conclusions from this small number of cases, it is plausible that the use of ethylene vinyl alcohol during SSE may result in a higher risk of permanent cranial neuropathy than the use of other well-established and more temporary agents. Knowledge of the arterial supply to the cranial nerves can help the clinician to choose the embolization agent that will provide maximal occlusion while minimizing the risk of complications.",
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AU - Gluth, Michael B.

AU - Mowry, Sarah E.

AU - Aagaard-Kienitz, Beverly L.

AU - Baskaya, Mustafa K.

AU - Gubbels, Samuel P.

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N2 - OBJECTIVE: To report 3 unique cases of cranial neuropathy after super-selective arterial embolization of jugular foramen vascular tumors with ethylene vinyl alcohol. STUDY DESIGN: Clinical capsule report. SETTING: Three tertiary academic referral hospitals. PATIENTS: Three patients who underwent superselective arterial embolization (SSE) of head and neck paragangliomas with ethylene vinyl alcohol are described. One individual was treated with primary SSE, whereas the remaining tumors were treated with preoperative SSE followed by surgical extirpation within 72 hours. All patients were found to have new cranial nerve deficits after SSE. RESULTS: One patient with isolated complete cranial nerve VII palsy demonstrated partial return of function at 8 months. One individual experienced cranial nerve VII, X, and XII palsies and demonstrated partial recovery of function of the involved facial nerve after 19 months. One subject experienced ipsilateral cranial nerve X and XI palsies after SSE and recovered full function of the spinal accessory nerve within 1 week but failed to demonstrate mobility of the ipsilateral true vocal fold. CONCLUSION: We present the first report documenting facial and lower cranial neuropathies after super-selective embolization of head and neck paragangliomas with EVA. Although it is difficult to draw conclusions from this small number of cases, it is plausible that the use of ethylene vinyl alcohol during SSE may result in a higher risk of permanent cranial neuropathy than the use of other well-established and more temporary agents. Knowledge of the arterial supply to the cranial nerves can help the clinician to choose the embolization agent that will provide maximal occlusion while minimizing the risk of complications.

AB - OBJECTIVE: To report 3 unique cases of cranial neuropathy after super-selective arterial embolization of jugular foramen vascular tumors with ethylene vinyl alcohol. STUDY DESIGN: Clinical capsule report. SETTING: Three tertiary academic referral hospitals. PATIENTS: Three patients who underwent superselective arterial embolization (SSE) of head and neck paragangliomas with ethylene vinyl alcohol are described. One individual was treated with primary SSE, whereas the remaining tumors were treated with preoperative SSE followed by surgical extirpation within 72 hours. All patients were found to have new cranial nerve deficits after SSE. RESULTS: One patient with isolated complete cranial nerve VII palsy demonstrated partial return of function at 8 months. One individual experienced cranial nerve VII, X, and XII palsies and demonstrated partial recovery of function of the involved facial nerve after 19 months. One subject experienced ipsilateral cranial nerve X and XI palsies after SSE and recovered full function of the spinal accessory nerve within 1 week but failed to demonstrate mobility of the ipsilateral true vocal fold. CONCLUSION: We present the first report documenting facial and lower cranial neuropathies after super-selective embolization of head and neck paragangliomas with EVA. Although it is difficult to draw conclusions from this small number of cases, it is plausible that the use of ethylene vinyl alcohol during SSE may result in a higher risk of permanent cranial neuropathy than the use of other well-established and more temporary agents. Knowledge of the arterial supply to the cranial nerves can help the clinician to choose the embolization agent that will provide maximal occlusion while minimizing the risk of complications.

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