PMC5487373_01
External carotid injection (A) and fluoroscopic working projections (B) show the tumoral blush. On the digital subtraction angiography performed directly after embolization (C) a residual contrast inflow is seen. A control angiogram taken 20 months later revealed significant tumor revascularization (D).
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Selective angiograms of the right external carotid artery (ECA) and superficial temporal arteries (STAs) showed a hypervascular mass with an intense tumor blush and early draining veins (Figure 1A). After determining an appropriate position of the microcatheter tip, endovascular occlusion of the paraganglioma vessels was performed under fluoroscopic guidance with micromolecules of polyvinyl alcohol (PVA) (Boston Scientific/Target Therapeutics, Cork Ltd., Cork, Ireland, Cordis J&J Endovascular, Miami, FL, USA) (100 mum) (Figure 1B). As it was impossible to reach smaller arterial feeders to achieve more distal embolization, the occlusion of the lesion was subtotal, which was confirmed by an immediate post-embolization angiogram (Figure 1C). Subsequent angiography was performed 20 months after the treatment and revealed significant tumor revascularization (Figure 1D).
PMC5487373_02
Axial (A) and coronal (B) T1+C magnetic resonance imaging sequences demonstrate a left-sided, homogeneously enhancing glomus jugulare tumor with a maximal diameter of 2.7 cm.
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A 66-year-old woman presented with a left-sided jugulo-tympanic paraganglioma with a maximal size of 27 mm (Figure 2). A follow-up angiogram taken one month later showed revascularization of the lesion (Figure 2).
PMC5487373_03
Left external carotid injection (A) presents a jugulo-tympanic paraganglioma tumoral blush. Two-staged embolization was performed with a subtotal effect of vascular occlusion (B). A control angiogram taken 13 months later revealed significant tumor revascularization (C).
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Following DSA, a two-staged partial embolization was performed via branches of the ECA with the application of micromolecules of PVA (150-255 mum) and PVA 100. (Figure 3A, 3B). A follow-up DSA performed 13 months later revealed an enlargement of the previously revealed tangle of vessels (Figure 3C).