Augmentation of N-butyl cyanoacrylate embolization of cranial, head, and neck tumors by simultaneous infusion of 5% dextrose solution.

BACKGROUND

N-Butyl cyanoacrylate (NBCA) is an adhesive liquid embolic agent widely used for embolization of cranial, head and neck tumors. Adequate distal penetration of NBCA into vessels with the smallest possible diameter, while preventing its reflux, is still a challenge, even in experienced hands. Simultaneous infusion of 5% dextrose in water solution (D5W) through the guiding catheter has been described before as a technique for improving embolization of dural arteriovenous malformations.

OBJECTIVE

To describe our experience with a modified D5W guide catheter push technique during embolization of hemorrhagic cranial, head and neck tumors. The embolization technique and pitfalls which might lead to complications are discussed in detail.

MATERIALS: A retrospective series of 20 patients treated with the D5W push technique during embolization of cranial, head and neck lesions between 2007 and 2013 is presented. The goal of embolization was preoperative or palliative embolization of hemorrhagic tumors. Localization and histopathologic diagnosis of lesions, concentration of NBCA used, subsequent surgical treatment, intraoperative blood loss, and complications were evaluated.

RESULTS

A total of 44 arterial pedicles were embolized during 22 treatment sessions. Adequate embolization of the lesions was achieved in all cases. Transient ischemic attack due to atheroma embolization (from the aorta) was seen in one patient (4%). Persistent vascularity of tumor associated with minimal intraoperative bleeding was reported in one patient (4%). Recurrence of epistaxis was reported in two patients diagnosed with Osler-Weber-Rendu syndrome.

CONCLUSIONS

The D5W push technique during NBCA embolization of cranial, head and neck tumors is a safe and effective method to enhance penetration of the embolizing agent.