Pre-surgical embolization of carotid body paragangliomas: advantages of direct percutaneous approach and transitory balloon-occlusion at the origin of the external carotid artery

Purpose Different embolization techniques and materials are available for the pre-operative embolization of carotid body paragangliomas. In this study, we report the first experience of the direct percutaneous puncture technique under fluoroscopic guidance using the low-viscosity formula of SQUID-12. The additional use of a transitory balloon-blockage at the origin of the external carotid artery aims to confer higher protection by limiting the risk of non-target embolization and subsequent neurological sequelae. Materials and Methods We retrospectively reviewed all cases of carotid body paragangliomas that have undergone pre-surgical embolization with a direct puncture technique and balloon-assistance at our institution between 2019 and 2020. The use of the liquid EVOH-based SQUID-12 as the sole embolic agent was the main inclusion criteria. Results A total of 9 patients with 9 carotid body paragangliomas were enrolled in this case series. The mean volume of the lesion was 309 mm3. The mean embolization-session time amounted to 88 min. The average number of needles inserted was 2, and the mean volume of SQUID-12 used per case was 23 ml. Successful total devascularization was obtained in all cases. No long-term sequelae due to the embolization procedure occurred. Conclusions Pre-operative paraganglioma embolization with SQUID-12 using a direct puncture and balloon-assisted technique is a safe and efficient method with few complications.