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Emergency - 66520100 |
Doctors On Call |
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PREOPERATIVE EMBOLIZATIONS OF TUMORS
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TUMOR EMBOLIZATION & EPISTAXIS
There are several groups of patients in whom bleeding from a tumor needs to be controlled. This may include pre-operative treatment of neck masses (paragangliomas and juvenile angiofibromas) or skull base lesions (meningiomas) to decrease the time and risk of surgery. Other patients with radiation and recurrence of head and neck cancers of the tongue or pharynx/larynx may require treatment to stop bleeding while more definitive treatment is implemented. These patients are usually few days prior to surgery.
Patients with epistaxis, persistent severe nose bleeding may also benefit from embolization. Although collateral circulation may open up within two weeks after the embolization, it is usually enough to allow adequate healing in 90% of patients with epistaxis. A few patients may need a second treatment, and there are some blood vessels, which arise from the ophthalmic artery, which cannot be treated by embolization. These can be treated by surgical intervention by ENT surgeons. We closely work with ENT doctors to treat these patients. Once the diagnostic angiogram is completed, a microcatheter is passed through a guide catheter in the appropriate external carotid artery. Branches of this vessel supplying the nasal region are embolized with PVA particles, Gelfoam, coils or other material. For patient with epistaxis bilateral sphenopalatine arteries and the ipsilateral distal facial arteries are embolized. Some highly vascular lesions such as hemangiomas in the vertebral bodies may be treated with pure alcohol, a sclerosing agent, which decreases blood flow. The procedure takes 4-6 hours. Afterward, the patient’s leg needs to be kept straight for up to six hours depending on the closure of the arteriotomy.
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