ANGIOGRAPHY

The role of angiography is limited to preoperative demonstration of the vascular anatomy and/or preoperative devascularization of tumors by embolization. Because of their highly vascular nature, glomus tumors demonstrate a well-defined tumor blush on angiography. Carotid body tumors are located within the carotid bifurcation, and result in splaying of the internal and external carotid arteries as they enlarge.

MRI, MRA and isotope scaning techniques are useful adjuncts in the screening for multicentric glomus tumors, but they are less sensative and less specific than angiography. DSA is the preferred diagnostic procedure. Four vessel angiographic evaluation of carotid and vertebral arteries is needed to identify multiple and bilateral glomus tumors. Angiography helps in pre-operative planning and in assessing the carotid circulation.

Presurgical embolization of large glomus tumors helps not only to reduce the tumor vascularity and peroperative bleed, but also helps in periadventitial resection of tumor and in effort to preserve the integrity of the carotid arteries. Carotid wall invasion by the tumor may need segmental carotid artery resection and reconstruction.