HSC Section 8_April 2017

Jugular Paragangliomas

Fig. 4. ( A ) Axial cut T1 MRI with contrast showing a left endolymphatic sac tumor. The tu- mor is designated by the white arrow. ( B ) Coronal cut T1 MRI with contrast showing a left endolymphatic sac tumor. The tumor is designated by the white arrow.

MANAGEMENT Embolization

Techniques of preoperative, transfermoral angiography with superselective emboliza- tion of feeding vessels have improved dramatically. Preoperative embolization may result in less intraoperative blood loss, thereby improving visualization, reducing morbidity, and increasing the probability of complete resection. Preoperative emboli- zation is generally performed 24 to 72 hours before surgery. The authors’ center most commonly uses Onyx (Covidien, Ireland), a nonadhesive liquid embolic agent. The au- thors’ experience, thus far, is encouraging that the degree of embolization achievable with Onyx may decrease the need for intraoperative blood transfusion relative to other

Fig. 5. High-resolution CT demonstrating the expected growth pattern of a GJT relative to the bone of the lateral skull base. The white arrow designates an area of tumor-associated bony destruction. ( A ) is an axial cut; ( B ) is a coronal cut.

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