Abstract / Summary
Background/Objectives: Head and neck paragangliomas are rare, but hypervascular tumors for which preoperative embolization is often required to mitigate intraoperative blood loss. This study compares intraoperative and histopathological outcomes of paragangliomas following preoperative embolization using particles, EVOH, or nBCA. Methods: Retrospective analysis of patients undergoing preoperative embolization for paragangliomas at a tertiary care center from 2010 to 2025. Outcomes included post-embolization angiographic devascularization, intraoperative blood loss, histopathological tumor necrosis, inflammatory response, and surgical resection. Results: Twenty-four patients (17 female; median age 51.5 years) were included. The median interval between embolization and surgery was 1.5 days. Liquid embolic agents (EVOH: 54.2%, nBCA: 25.0%) were used in 79.2% of cases, with particles in the rest. Liquid embolics demonstrated superior angiographic tumor devascularization (median 90% vs. 50%, p = 0.036) and histopathological necrosis (30% vs. 0%, p = 0.019) compared to particles. However, no significant differences were observed in intraoperative blood loss (hemoglobin loss 1.4 g/dL for liquid embolics vs. 0.5 g/dL, p = 0.634), or intervention duration (137 min vs. 96 min, p = 0.053). Complete tumor resection (R0) was achieved in 74% of liquid embolic cases versus 100% with particles. EVOH and nBCA showed comparable embolization efficacy. Conclusions: Liquid embolic agents achieved greater tumor devascularization and necrosis than particles, though surgical outcomes (blood loss, operative time, complete resection rates) were comparable.