Preoperative Percutaneous ONYX Embolization of Carotid Body Tumor: A Case Report
Jason T. Ryan, MD, Loay Kabbani, MD, Sara Wasilenko, DO, Horia Marin, MD.
Henry Ford Hospital, Detroit, MI, USA.
Objectives: To highlight and review the utilization of preoperative percutaneous ONYX embolization of a Carotid body tumor in a single patient.
Methods and Background: Carotid body tumors represent a rare entity but are the most common paraganglioma in the head and neck. Advances in surgical technique and perioperative modalities have reduced the complication rate related to resection. Preoperative embolization decreases the amount of blood loss for larger tumors. Traditionally, preoperative transarterial embolization has been used to reduce intraoperative blood loss during tumor resection. Direct percutaneous embolization provides an alternative route for embolization. This is a case report of successful preoperative percutaneous ONYX embolization of a Carotid Body Tumor.
Results and Case Presentation: 81-year-old female who presented with a palpable neck mass. CT imaging of the neck revealed a 2.2 x 2.3 cm mass splaying apart the carotid bifurcation suggestive of carotid body tumor or Schwannoma. Findings were confirmed on duplex ultrasound with no evidence of significant carotid stenosis. Metabolic activity workup was negative. The decision was made to perform preoperative tumor embolization of this tumor using a percutaneous technique with direct injection of Onyx glue (2ml). Pre and post injection angiograms confirmed cessation of blood flow into the mass. After 48 hours she underwent successful excision of the carotid body tumor with minimal blood loss and without the need for arterial clamping. Pathology confirmed it as a paraganglioma. She recovered uneventfully.
Conclusion: Preoperative direct percutaneous embolization of carotid body tumors is a safe and effective alternative to transarterial embolization and should be considered for medium and large carotid body tumors. Further investigation into perioperative neurologic complications and peri-tumoral inflammatory changes related to technique of embolization should be considered. 
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