Impact of Preoperative Embolization on Surgical Outcomes in Carotid Paraganglioma Resection: A Retrospective Cohort Study

This retrospective cohort study evaluates the impact of preoperative embolization (PE) on surgical outcomes in carotid paraganglioma resections. Carotid paragangliomas are rare, highly vascular tumors that pose significant surgical challenges due to their proximity to critical neurovascular structures. Although PE has been proposed to reduce intraoperative bleeding, operative time, and complications, its efficacy remains debated. Clinical records of 56 patients undergoing 63 resections between 2007 and 2021 at the Instituto De Seguridad Social Del Estado De México Y Municipios State Cancer Center were analyzed. Outcomes assessed included intraoperative bleeding, surgical time, hospital stay, cranial nerve and vascular complications, transfusion requirements, and late neurological sequelae. While embolization did not provide statistically significant benefits across the overall cohort, subgroup analysis revealed notable advantages in Shamblin III tumors. In this group, embolization was associated with reduced bleeding (223 mL vs. 550 mL, p=0.038), shorter operative time (146.7 min vs. 223 min, p=0.048), and decreased hospital stay (2.17 vs. 5.40 days, p=0.004). Vascular complications and late sequelae were also significantly lower in embolized Shamblin III cases (5.6% vs. 40%, p=0.043). No significant differences were observed in short-term neurological outcomes between embolized and non-embolized groups. These findings suggest that PE may offer surgical benefits in select high-risk patients, particularly those with advanced-stage tumors, while its routine use in Shamblin I and II cases appears unwarranted. Individualized decision-making based on tumor classification and surgical context remains essential to optimizing outcomes.