Role of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis

Pavlos Texakalidis, Nektarios Charisis, Stefanos Giannopoulos, Dimitrios Xenos, Leonardo Rangel-Castilla, Apostolos K Tassiopoulos, Pascal Jabbour, Jonathan A Grossberg, Theofilos Machinis
World Neurosurgery 2019, 129: 503-513.e2

BACKGROUND: Carotid body tumors (CBTs) are highly vascularized tumors which can render tumor resection surgery challenging. There is evidence suggesting that preoperative selective embolization can reduce blood loss during surgery and decrease the risk of perioperative complications; however, recent reports have questioned the benefits that preoperative embolization provides. The objective of this study is to investigate the impact of preoperative embolization on CBT surgical resection.

METHODS: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies were identified through a search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials until March 2019. A random effects model meta-analysis was conducted, and the I2 statistic was used to assess for heterogeneity.

RESULTS: Twenty-five studies comprising 1326 patients were included. Patients who received preoperative embolization had statistically significant lower intraoperative blood loss (weighted mean difference [WMD], -135.32; 95% confidence interval [CI], -224.58 to -46.06; I2  = 78.6%). Duration of the procedure was statistically significantly shorter in the preembolization group than the nonembolization group (WMD, -38.61; 95% CI, -65.61 to -11.62; I2  = 71.9%). There were no differences in the rates of cranial nerve (CN) injuries (odds ratio [OR], 1.13; 95% CI, 0.68-1.86; I2  = 12.9%), stroke (OR, 1.75; 95% CI, 0.70-4.36; I2  = 0%), transient ischemic attacks (TIAs) (OR, 0.55; 95% CI, 0.11-2.65; I2  = 0%), or length of stay (WMD, 0.32; 95% CI, -1.35 to 1.98; I2  = 96.4%) between the 2 groups.

CONCLUSIONS: Patients who received embolization prior to CBT resection had statistically significant lower blood loss and shorter duration of operation. The rates of CN palsy, stroke, TIA, and length of stay were similar between patients who had preoperative embolization and those who did not.

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