PREOPERATIVE EMBOLISATION -RISKS &BENEFITS скачать в хорошем качестве

PREOPERATIVE EMBOLISATION -RISKS &BENEFITS

Preoperative Embolization in Head and Neck Paragangliomas Instructor: Today, we’re discussing preoperative embolization in the management of head and neck paragangliomas (HNPs). This technique is used to reduce intraoperative bleeding and decrease tumor size, which helps in surgical removal. However, its role remains controversial. Let’s dive into the details. Rationale for Preoperative Embolization • One of the main benefits is reducing blood supply to the tumor, which leads to: • Decreased intraoperative bleeding, minimizing the need for blood transfusions. • Smaller tumor size, making resection easier. • Shorter operative time, leading to a smoother surgical procedure. • Despite these advantages, some studies indicate that embolization may not significantly impact blood loss, transfusion requirements, or cranial nerve injury risk. However, it does increase overall healthcare costs. Complications of Embolization While embolization is beneficial, it is not without risks. Some potential complications include: 1. Cranial Nerve Injury • Temporary or permanent damage to the vagal, facial nerves, leading to dysphagia, facial weakness, or vocal cord paralysis. • Visual field defects due to embolization of ophthalmic branches. • Jugular foramen syndrome, resulting from combined lower cranial nerve dysfunction. 2. Neurological Complications • Transient hemiparesis (temporary weakness on one side of the body). • Stroke if embolic material enters cerebral circulation. • Vertebral artery dissection, which can cause brainstem ischemia. 3. Vascular and Access Site Issues • Groin site complications, such as hematoma or infection at the femoral artery puncture site. Optimizing the Embolization Process • Embolization should be performed within 2 days before surgery to: • Prevent revascularization via collateral circulation. • Avoid post-embolization inflammation, which can make surgery more difficult. • A multidisciplinary team of interventional radiologists and head and neck surgeons is crucial for planning and execution. Conclusion Preoperative embolization is a valuable tool for improving surgical outcomes in head and neck paragangliomas, but it must be used judiciously, considering its potential complications. Careful patient selection and expertise in embolization techniques are key to maximizing benefits while minimizing risks. #science #biology #ear #ent #nose #anatomy #nosebleed #otolaryngology #throathealth #tonsils