197 / 264
MANAGEMENT
Embolization
Techniques of preoperative, transfermoral angiography with superselective emboliza-
tion of feeding vessels have improved dramatically. Preoperative embolization may
result in less intraoperative blood loss, thereby improving visualization, reducing
morbidity, and increasing the probability of complete resection. Preoperative emboli-
zation is generally performed 24 to 72 hours before surgery. The authors’ center most
commonly uses Onyx (Covidien, Ireland), a nonadhesive liquid embolic agent. The au-
thors’ experience, thus far, is encouraging that the degree of embolization achievable
with Onyx may decrease the need for intraoperative blood transfusion relative to other
Fig. 4.
(
A
) Axial cut T1 MRI with contrast showing a left endolymphatic sac tumor. The tu-
mor is designated by the white arrow. (
B
) Coronal cut T1 MRI with contrast showing a
left endolymphatic sac tumor. The tumor is designated by the white arrow.
Fig. 5.
High-resolution CT demonstrating the expected growth pattern of a GJT relative to
the bone of the lateral skull base. The white arrow designates an area of tumor-associated
bony destruction. (
A
) is an axial cut; (
B
) is a coronal cut.
Jugular Paragangliomas
176