scholarly journals Effects of Preoperative Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids' Inpatient Database

2020 ◽  
Author(s):  
Jonathan S. Choi ◽  
Justin Yu ◽  
Benjamin D. Lovin ◽  
Alyssa C. Chapel ◽  
Akash J. Patel ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Surgical Outcomes ◽  
Health Care Cost ◽  
Hospital Costs ◽  
Hospital Length Of Stay ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Nasopharyngeal Angiofibroma ◽  
Inpatient Database ◽  
Perioperative Blood Transfusion

Abstract Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database. Methods The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients. Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing. Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.

Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma

2018 ◽  
Vol 127 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Kareem O. Tawfik ◽  
Jeffrey J. Harmon ◽  
Zoe Walters ◽  
Ravi Samy ◽  
Alessandro de Alarcon ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Facial Nerve ◽  
Blood Supply ◽  
Facial Palsy ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Potential Complication ◽  
Nasopharyngeal Angiofibroma

Objectives: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. Methods: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. Results: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Conclusions: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

Transnasal microscopic approach for juvenile nasopharyngeal angiofibroma

2018 ◽  
Vol 72 (5) ◽  
pp. 31-36 ◽  
Author(s):  
Wiesław Gołąbek ◽  
Anna Szymańska ◽  
Kamal Morshed
Keyword(s):  
Infratemporal Fossa ◽  
Surgical Excision ◽  
Vascular Tumor ◽  
Stage I ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Stage Iiia ◽  
Nasopharyngeal Angiofibroma ◽  
Feeding Vessels

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor originating in the nasopharynx. The treatment of choice for JNA is surgical excision. In recent years, surgical management has been greatly influenced by the use of the transnasal endoscopic technique. The aim: The aim of the study was to present our experience with the transnasal microscopic removal of JNA. Material and methods: Ten patients with JNA aged 12-17 underwent diagnostics imaging and transnasal microscopic tumor excision. Medical records of patients were retrospectively reviewed. The main outcome measures were complications and recurrences. Preoperative embolization of feeding vessels was performed in 7 patients. Results: According to Andrews’ classification, the group included 2 stage I patients, 6 stage II patients and 2 stage IIIA patients with the extensive occupation of the infratemporal fossa. 9 patients had no recurrence in 6-11 years follow up. One stage IIIA patient had a recurrence posteriorly to the pterygopalatine process and it was completely removed. No complications during or after surgery occurred. Conclusion: Transnasal microscopic excision is an effective approach to resect stage I-IIIA JNA

scholarly journals Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

2021 ◽  
Vol 10 (17) ◽  
pp. 3926
Author(s):  
Andrea Giorgianni ◽  
Stefano Molinaro ◽  
Edoardo Agosti ◽  
Alberto Vito Terrana ◽  
Francesco Alberto Vizzari ◽  
...  
Keyword(s):  
Blood Loss ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

scholarly journals Multidisciplinary management of juvenile nasopharyngeal angiofibroma

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Walid Abouzeid ◽  
Ahmed Sultan ◽  
Mohamed Shadad
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Endoscopic Resection ◽  
Arterial Embolization ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Imaging Evaluation ◽  
Tissue Mass ◽  
Nasopharyngeal Angiofibroma ◽  
Male Patients

Abstract Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign, but the locally aggressive, vascular tumor that occurs almost exclusively in young men. Although this tumor accounts for only about 0.5% of head and neck tumors, it is by far the most common benign nasopharyngeal neoplasm. It is presented typically with epistaxis, obstructive symptoms, and chronic otomastoiditis. The examination of this tumor reveals pale reddish-blue mass. The tumor is seen on imaging as vividly augmenting soft-tissue mass centered on the sphenopalatine foramen. The treatment of choice is usually surgical resection; either open or endoscopic. Pre-operative embolization is usually done to help with hemostasis. We aim to address the efficiency and the safety of endovascular modality in JNA. Methods In the period between January 2012 to December 2017, 20 male patients with age ranging from 6 to 20 years were referred to the Endovascular Unit, at Departments of Neurosurgery in Sohag, Alexandria, and Tanta University Hospitals with JNF. Preoperative trans-arterial embolization was done, followed by endoscopic surgical resection by our ENT surgeons. All patients were subjected to clinical and radiological Imaging evaluation pre embolization, post embolization, and post endoscopic resection. All patients had clinical and radiological follow-ups for at least 1 year. Results 20 male patients with JNA underwent preoperative super-selective trans-arterial embolization. The average age at presentation was 13 years. All patients underwent successful embolization with total obliteration of vascular blush of the tumor in 15 patients, and near-total obliteration of blush in 5 patients. The dramatic effect of preoperative embolization was observed on limiting intraoperative blood loss (average 200 ml) and decreasing the time of surgery (average 2.5 h). There was no permanent morbidity or mortality related to either embolization or endoscopic resection in all patients. Conclusions Trans-arterial embolization is strongly recommended in patients with JNA, it offers a good assist to the surgeon, reduces blood loss, decreases the amount of transfusion, improves the degree of resection, reduces operative time, and decreases the incidence of recurrence.

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