Effect of Preoperative Superselective Embolization in the Resection of Hypervascular Tumors of the Central Nervous System, Neck, and Nasal Cavity.

Background Hypervascular head and neck tumors, such as paragangliomas, esthesioneuroblastomas, and juvenile nasopharyngeal angiofibromas (JNA), are surgically challenging due to their rich vascular supply and proximity to critical structures. Preoperative superselective embolization may optimize surgical outcomes by reducing intraoperative bleeding and facilitating safe resections. Methods We conducted a retrospective case-control study of patients with hypervascular tumors of the central nervous system, neck, and nasal cavity treated between 2019 and 2024 at a single tertiary neurosurgical center. Patients were divided into embolization and non-embolization groups. Outcomes included the extent of resection, intraoperative blood loss, transfusion requirements, operative time, hospital stay, and complications. Results Fifty patients were analyzed (mean age 42.9 years; 58% female). Half underwent preoperative embolization, more frequently in nasal tumors (64%). Diagnoses included paraganglioma (46%), JNA (28%), and esthesioneuroblastoma (26%). Ethylene-vinyl alcohol copolymer was used in 96% of embolizations. Embolized patients had higher complete resection rates (100% vs. 84.6%; p<0.001), less blood loss (263.7 vs. 978.0 mL; p<0.001), fewer transfusions (16% vs. 84%; OR: 27.56), and shorter hospital stays (1.84 vs. 6.00 days; p<0.001). Complications were uncommon (8%) and transient. Conclusion Preoperative superselective embolization, particularly with ethylene-vinyl alcohol copolymer, is a safe and effective adjunct that improves resection rates, reduces perioperative morbidity, and optimizes surgical outcomes in hypervascular head and neck tumors.