Preoperative embolisation of a hypervascular, calvarial paraganglioma metastasis via a combined percutaneous and transophthalmic arterial approach.

A 30-year-old male patient with a history of malignant, metastatic paraganglioma presented with a rapidly enlarging, expansile left calvarial mass. CT and ultrasound imaging demonstrated a 60×46×31 mm soft-tissue lesion centred on the left frontal bone which was markedly hypervascular (figure 1A,B).Figure 1 (A) non-contrast CT demonstrating the left-sided expansile calvarial lesion with osseous destruction and frontal lobe compression (black arrow). (B) Colour flow Doppler ultrasound of the lesion demonstrating pronounced hypervascularity (white arrows). (C) Lateral left external carotid artery DSA demonstrating extensive superficial scalp supply to the lesion from multiple, enlarged superficial temporal artery (black arrowheads) and occipital artery (white arrowheads) branches. (D) Lateral left internal carotid artery DSA demonstrating deep dural arterial supply to the lesion from the MMA (white arrowheads) originating from the ophthalmic artery (black arrowhead). DSA, digital subtraction angiogram; MMA, middle meningeal artery.A cerebral …