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Abstract
Introduction Direct puncture embolization has emerged as a promising technique for the embolization of hypervascular lesions, offering a minimally invasive alternative to the traditional transarterial approach. Conventional transarterial embolization relies on superselective catheterization of feeding vessels which sometimes can be tedious or not achievable, leading to incomplete devascularizations. If superselective catheterization cannot be achieved, nontarget embolization carries the risk of ischemic complications. Instead, direct puncture embolization involves accessing lesion directly through endonasal, transoral or percutaneous puncture, using imaging guidance. This approach has the potential to enhance lesion targeting, minimize procedural complexity, and reduce risk of non-target embolization.
Method In this study, we present approach and outcomes of embolization performed on five hypervascular oropharyngeal and nasopharyngeal lesions. The embolization involved direct puncture of lesion using endonasal or transoral approaches.
Result All 5 patients had transfemoral cerebral angiogram for therapeutic planning, with assessment of extent of the lesion, optimal treatment approach and to assist in precise localization. Transnasal and transoral biopsy was performed under fluoroscopic guidance. Endonasal endoscopy was used adjunctively in one case. Direct injection of contrast agent into the lesion revealed local parenchymography. No significant arterial reflux was noted. Progressive embolization was performed using a coaxial via a 19G trocar through a 20G spinal needle under reversed roadmap visualization. Adjunctive transarterial embolization was performed in 3 cases. Total or near total devascularization was achieved in all cases. Pathological diagnosis was consistent with hemangioma in 3 cases, JNA and arterio-venous malformation in other 2 cases.
Conclusion Embolization of hypervascular oral and nasal lesions using Onyx via direct puncture can be conducted safely and efficiently, yielding favorable outcomes. Direct puncture embolization is correlated with reduced duration of embolization procedures and leads to more extensive tumor devascularization. Despite advantages, direct puncture embolization demands precise patient selection, thorough pre-procedural planning for successful execution.
Disclosures P. Patel: None. H. Marin: None. M. Kole: None. A. Chebl: None. P. Entezami: None.