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.

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 Transnasal Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma without Preoperative Embolization

2006 ◽  
Vol 85 (11) ◽  
pp. 740-746 ◽  
Author(s):  
Peyman Borghei ◽  
Mohammad Hossein Baradaranfar ◽  
Seyed Hebatodin Borghei ◽  
Farnoosh Sokhandon
Keyword(s):  
Endoscopic Resection ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Nasopharyngeal Angiofibroma

Current Management of Juvenile Nasopharyngeal Angiofibroma: A Tertiary Center Experience 1999–2007

2009 ◽  
Vol 23 (3) ◽  
pp. 328-330 ◽  
Author(s):  
Benjamin S. Bleier ◽  
David W. Kennedy ◽  
James N. Palmer ◽  
Alexander G. Chiu ◽  
Jason D. Bloom ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Endoscopic Resection ◽  
Tertiary Care ◽  
Current Trend ◽  
Treatment Algorithm ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Nasopharyngeal Angiofibroma ◽  
Average Hospital ◽  
Tertiary Center

Background Over the past 10 years, the management of juvenile nasopharyngeal angiofibroma (JNA) has been redefined because of the improvement of transnasal skull base techniques. However, the limits of endoscopic resection still have to be fully defined. The purpose of this study was to report on a series of patients presenting with JNA in an effort to further define an optimal treatment algorithm and improve outcomes. Methods A retrospective review was performed of 18 patients presenting to a tertiary care institution with JNA from 1999 to 2007. Patients were categorized by Andrews stage and data were collected on presentation, operative technique, and postoperative course. Results All patients underwent preoperative embolization. Stages 1, 2, and one 3a lesions were approached endoscopically while the remainder underwent open resection. In the endoscopic group the intraoperative blood loss was almost half that of the open group (506 versus 934 mL) and the average hospital stay was 1 day less (3 vs. 4 days). Conclusion Endoscopic resection is reasonable for Andrews stage 1, 2, and select 3a lesions and may allow for less bleeding and a shorter hospital stay. This study supports the current trend of expansion of indications for endoscopic JNA resection.

Coblation-assisted endonasal endoscopic resection of juvenile nasopharyngeal angiofibroma

2011 ◽  
Vol 125 (9) ◽  
pp. 940-944 ◽  
Author(s):  
L Ye ◽  
X Zhou ◽  
J Li ◽  
J Jin
Keyword(s):  
Blood Loss ◽  
Endoscopic Resection ◽  
Class I ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Tumour Resection ◽  
Operative Blood Loss ◽  
Nasopharyngeal Angiofibroma ◽  
Endoscopic Techniques ◽  
Significant Difference ◽  
Complete Tumour

AbstractObjective:Juvenile nasopharyngeal angiofibroma may be successfully resected using endoscopic techniques. However, the use of coblation technology for such resection has not been described. This study aimed to document cases of Fisch class I juvenile nasopharyngeal angiofibroma with limited nasopharyngeal and nasal cavity extension, which were completely resected using an endoscopic coblation technique.Methods:We retrospectively studied 23 patients with juvenile nasopharyngeal angiofibroma who underwent resection with either traditional endoscopic instruments (n = 12) or coblation (n = 11). Intra-operative blood loss and overall operative time were recorded.Results:The mean tumour resection time for coblation and traditional endoscopic instruments was 87 and 136 minutes, respectively (t = 9.962, p < 0.001). Mean intra-operative blood loss was 121 and 420 ml, respectively (t = 28.944, p < 0.001), a significant difference. Both techniques achieved complete tumour resection with minimal damage to adjacent tissues, and no recurrence in any patient.Conclusion:Coblation successfully achieves transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma (Fisch class I), with good surgical margins and minimal blood loss.

Preoperative Superselective Arteriolar Embolization: A New Approach to Enhance Resectability of Spinal Tumors

Neurosurgery ◽  
1990 ◽  
Vol 27 (5) ◽  
pp. 755-759 ◽  
Author(s):  
W. C. Broaddus ◽  
M. S. Grady ◽  
J. B. Delashaw ◽  
R. D. G. Wisoff ◽  
J. A. Jane
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Arterial Embolization ◽  
Technical Difficulty ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Collateral Flow ◽  
Extensive Resection ◽  
Estimated Blood Loss ◽  
Key Factor

Abstract The extent of surgical resection of spinal tumors is frequently limited by blood loss and technical difficulty associated with the vascularity of the tumors. We report here the use of superselective percutaneous arterial embolization to reduce the rate of blood loss at the time of surgical resection and enhance resectability. The types of tumors treated were metastatic renal carcinoma, metastatic thyroid carcinoma, metastatic melanoma, and giant cell tumor of the sacrum. Two of the patients required repeated embolization and surgery for recurrent symptoms. The estimated blood loss in seven of nine procedures performed on the six patients ranged from 300 to 800 ml, after which no transfusion was required. In two procedures, extensive resection of very large tumors resulted in larger losses of blood, and postoperative transfusion was necessary. No significant complications of embolization or surgery occurred. A key factor in our embolization technique is the use of microfibrillar collagen, which allows occlusion of tumor vessels as small as 20 µm and may prevent reconstitution of the embolized vessels by collateral flow. We conclude that preoperative arterial embolization enhances the resectability of a variety of spinal tumors by reducing intraoperative blood loss. This may provide an additional benefit by reducing the risk related to postoperative transfusion. By permitting a more aggressive surgical approach, the use of preoperative embolization also has the potential to improve outcome in patients with spinal tumors.

scholarly journals Radiation Therapy Improves Local Control in Juvenile Nasopharyngeal Angiofibroma following Disease Progression after Embolization and Surgical Resection: A Case Report

2021 ◽  
pp. 739-745
Author(s):  
Zane Blank ◽  
Richard Sleightholm ◽  
Beth Neilsen ◽  
Michael Baine ◽  
Chi Lin
Keyword(s):  
Radiation Therapy ◽  
Disease Progression ◽  
Surgical Resection ◽  
Local Control ◽  
Benign Neoplasm ◽  
Good Prognosis ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Adjuvant Radiation ◽  
Nasopharyngeal Angiofibroma ◽  
Presenting Symptoms

Juvenile nasopharyngeal angiofibroma (JNA) is a relatively uncommon, benign neoplasm of the nasopharynx that can be very difficult to diagnose early due to inconspicuous and seemingly harmless presenting symptoms. Early diagnosis and treatment of JNA are essential for a good prognosis. JNA typically responds well to radiation therapy (RT), but when it does not, the most appropriate next course of action has not been readily defined due to the limited occurrence and experience with this neoplasm. Herein, we describe a JNA patient, who continued to progress after surgery and 36 Gy of adjuvant radiation, but after an additional 14.4 Gy, he has remained in remission for over 2 years. An 11-year-old boy who presented with JNA underwent treatment with embolization and surgical resection. Unfortunately, the tumor progressed within 2 months of surgical intervention and he required RT for adequate local control. While undergoing RT, he again demonstrated signs of progression; so his radiation regimen was increased from 3,600 cGy in 20 fractions to 5,040 cGy in 28 fractions. Since completing RT, the tumor has continued to decrease in size, and the patient is stable and has been without signs of disease progression for over 24 months now. Thus, escalating the radiation regimen to 5,040 cGy may improve local control in rapidly progressive JNA.

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