头颈部副神经节瘤的术前栓塞治疗

Preoperative Embolization of Paragangliomas of the Head and Neck

目的：分析头颈部副神经节瘤的ＤＳＡ表现及评价术前栓塞的作用。材料与方法：８例患者均行双侧颈总动脉及椎动脉ＤＳＡ检查，而后行患侧超选择性插管，以明胶海绵颗粒或真丝线段作为栓塞材料。结果：５例颈静脉球瘤，２例颈动脉体瘤及１例迷走神经体瘤的动脉期均显示主要由颈外动脉的分支供血，如咽升动脉、耳后动脉、枕动脉等。颈静脉球瘤如侵犯后颅凹，颈内动脉或椎动脉的分支也可参与供血。实质期，肿瘤呈分叶状、不均匀染色；静脉期，２例颈静脉球瘤可见增粗之引流静脉向颈内静脉引流。所有肿瘤经栓塞后在７天内行手术切除。结论：ＤＳＡ是显示头颈部副神经节瘤供血动脉的最佳方法，可以精确确定肿瘤的部位及侵犯范围。术前栓塞治疗可以有效地阻断肿瘤的供血动脉而无严重的并发症。

Objective: To analyse the DSA findings and evaluate the role of preoperative embolization of paraganglioma of the head and neck.Materials and Methods:8 patients were undergone bilateral carotid artery DSA, vertebral artery DSA, and then superselective catheterization were performed. Particles of gelfoam or silk thread was used as embolic material.Results:5 cases of glomus jugulare tumors, 2 cases of carotid body tumors and 1 case of glomus vagale tumor were demonstrated. Arterial phase of DSA showed all tumors were major suppied by the branches of external carotid artery, such as the assending pharyngeal artery, posterior auricular artery, occipital artery, and so on. The branches of the internal carotid artery and the vertebra artery might also be the contributor of glomus jugulare tumors if the tumor extended into the posterior fossa. Obvious inhomogeneous, locally tumor stain could be seen in the capillary phase. Enlarged veins of 2 glomus jugulare tumors drainaged into the internal carotid vein. All of the tumors were disvascularized after embolization and were resected by surgery within 7 days.Conclusion: DSA is the best way to demonstrate the feeding arteries of paraganglioma in the head and neck and it can define precisely the location and extention of tumor. Preoperative embolization may significantly improve the conditions when surgery is performed.