• Lucca B Palavani, Raphael Camerotte, Pari MitreLucasLFaculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil., Sávio Batista, Isabela Banderali, Marina Vilardo, Vieira NogueiraBernardoBFaculty of Medicine, Serra dos Órgãos University Center, Rio de Janeiro, Brazil., Vinicius Pereira, Leonardo Macedo, Raphael Bertani, Márcio S Rassi, and Jean G de Oliveira.
• Faculty of Medicine, Max Planck University Center, São Paulo, Brazil. Electronic address: lucca.palavani730@al.unieduk.com.br.
• World Neurosurg. 2024 Oct 1; 190: 487503.e4487-503.e4.

ObjectiveThis study aims to evaluate the efficacy and safety of preoperative embolization, used 48 hours before surgery to reduce tumor size and surgical complications in carotid body paragangliomas.MethodsThis systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Cochrane Handbook. A comprehensive literature search was performed in Medline, Embase, Web of Science, and Cochrane databases. The inclusion criteria were: 1) observational studies, 2) reporting on diagnosed carotid body paragangliomas, 3) undergoing preoperative embolization procedures, and 4) with ethylene-vinyl alcohol as an embolic agent.ResultsThe study analyzed 106 patients, aged 18-79, using primarily Onyx 18 for embolization, with treatment intervals ranging from 24 hours to 2 weeks. Efficacy outcomes showed near-total devascularization in 67% of cases (95% confidence interval [CI]: 0.47-0.87; I² = 74%), subtotal devascularization in 33% (95% CI: 0.12-0.54; I² = 43%), and total devascularization in 97% (95% CI: 0.88-1.00; I² = 41%), indicating significant heterogeneity across outcomes. The mean estimated blood loss was 184.46 ml (95% CI: 116.72-252.20 ml). Postembolization complication rate was exceptionally low at 1% (95% CI: 0.00-0.06; I² = 0%).ConclusionsIn conclusion, preoperative embolization of carotid body tumors achieved high rates of devascularization with minimal blood loss and a very low incidence of complications, highlighting its effectiveness and safety as a treatment strategy.Copyright © 2024 Elsevier Inc. All rights reserved.

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