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Laryngorhinootologie 2017; 96(01): 22-26
DOI: 10.1055/s-0042-105215
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

Perkutane Phil™-Embolisation zur präoperativen Therapie von Karotis-Paragangliomen

Percutaneous Phil™-Embolization for Preoperative Therapy of Carotid Body Paragangliomas
G. Psychogios
1   HNO-Klinik, Klinikum Augsburg, Augsburg
,
A. Berlis
2   Klinik für Diagnostische Radiologie und Neuroradiologie, Klinikum Augsburg, Augsburg
,
B. Märkl
3   Institut für Pathologie, Klinikum Augsburg, Augsburg
,
T. Schaller
3   Institut für Pathologie, Klinikum Augsburg, Augsburg
,
M. N. Psychogios
4   Abteilung für Neuroradiologie, Universitätsmedizin Göttingen, Göttingen
,
J. Zenk
1   HNO-Klinik, Klinikum Augsburg, Augsburg
› Author Affiliations
Further Information

Publication History

eingereicht 14 February 2016

akzeptiert 14 March 2016

Publication Date:
29 June 2016 (online)

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Zusammenfassung

Einleitung:Paragangliome sind seltene Tumore, welche eine therapeutische Herausforderung darstellen. Insbesondere die operative Entfernung kann zu lebensbedrohlichen Blutungen führen. Die präoperative perkutane Embolisation ist gegenüber der intraarteriellen Technik eine Alternative, die in kurzer Interventionszeit eine eine hohe Verschlussrate der tumorversorgenden Gefäße ermöglicht und damit entscheidend die intraoperative Blutungswahrscheinlichkeit reduziert. Die vollständige Tumorresektion wird dabei erleichtert. Der Einsatz eines neuen zugelassenen Flüssigembolisats wird hier vorgestellt.

Methoden: Im Klinikum Augsburg wurde eine 50-jährige Patientin mit 4 cm großen Paragangliom caroticum (Shamblin II) behandelt. Zunächst wurde eine perkutane Embolisation mit 7 ml PHIL™ (precipitating hydrophobic injectable liquid) durchgeführt. Nach 24 Stunden erfolgte die komplette operative Resektion des Tumors.

Ergebnisse: Eine gute Verteilung des flüssigen Embolisats über den gesamten Tumor konnte erzielt werden. Intraoperativ wurde die Resektion des Tumors aufgrund der geringen Blutungsneigung über die gesamte Tumoroberfläche deutlich erleichtert und beschleunigt. Der gesamte Blutverlust lag unter 50 ml. Alle benachbarten Nerven- und arteriellen Strukturen konnten geschont werden. Postoperativ zeigten sich keine Nervenfunktionsstörungen und die Patientin konnte am 4. postoperativen Tag entlassen werden.

Schlussfolgerung: Die Kombination aus perkutaner Embolisation und operativer Resektion bieten insbesondere für fortgeschrittene Paragangliome der Karotisbifurkation einen sicheren Therapieeinsatz. Die Verwendung eines neuen flüssigen Embolisats kann möglicherweise zukünftig die Therapie weiter optimieren.

Abstract

Introduction: Paragangliomas are rare tumors representing a therapeutic challenge. In particular, the surgical removal may lead to life-threatening bleeding. The preoperative percutaneous embolization is an alternative that allows a high closure rate of tumor-feeding vessels in a short intervention time and thus significantly reduces intraoperative bleeding probability. Complete tumor resection is facilitated thereby. The use of a new non-adhesive liquid embolic agent is presented here.

Methods: A 50-year old patient presented with 4 cm large paraganglioma of the carotid body (Shamblin II). A percutaneous embolization with 7 ml PHIL™ (injectable precipitating hydrophobic liquid) was performed preoperatively. 24 h later the complete surgical resection of the tumor was performed.

Results: A good distribution of the liquid embolic agent could be achieved over the entire tumor. Intraoperative resection of the tumor was much easier and faster due to low bleeding tendency over the entire surface of the tumor. Total blood loss was less than 50 ml. All adjacent nerve and arterial structures could be spared. Postoperative nerve function was normal and the patient was discharged on the 4th postoperative day.

Conclusion: The combination of percutaneous embolization and surgical resection provides a safe combination in the treatment of advanced carotid body paragangliomas. The use of a novel liquid embolic agent may possibly further optimize the therapy.

Schlüsselwörter

Paragangliom - perkutane Embolisation - Paragangliom caroticum - Karotisparagangliom - Phil - Fllüssigembolisat - Onyx

Key words

carotid body tumor - percutaneous embolization - glomus tumor - paraganglioma - phil - liquid embolic agent - Onyx
 

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