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.

Preoperative embolization of intracranial hemangiopericytomas: case series and introduction of the transtumoral embolization technique

2015 ◽  
Vol 8 (10) ◽  
pp. 1084-1094 ◽  
Author(s):  
Brian W Hanak ◽  
Diogo C Haussen ◽  
Sudheer Ambekar ◽  
Manuel Ferreira ◽  
Basavaraj V Ghodke ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Blood Loss ◽  
Blood Supply ◽  
Case Series ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Hypervascular Tumors ◽  
Polyvinyl Alcohol Particles

Background and purposeHemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx-18 through diminutive external carotid artery (ECA) feeders.MethodsA retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002–November 2014) and Anonymous University #2 (January 2014–November 2014) is presented.ResultsFifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4±10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9±26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0±34.6%; n=4) versus polyvinyl alcohol particles (33.3±15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=−0.71; p=0.005). There were no embolization-related complications.ConclusionsThe extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.

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.

Treatment of Large Juvenile Nasopharyngeal Angiofibroma

1992 ◽  
Vol 106 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Daniel G. Deschler ◽  
Michael J. Kaplan ◽  
Roger Boles
Keyword(s):  
Magnetic Resonance ◽  
External Carotid Artery ◽  
Magnetic Resonance Images ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
External Carotid ◽  
Nasopharyngeal Angiofibroma ◽  
Large Juvenile ◽  
Intracranial Disease ◽  
Preoperative Magnetic Resonance

The management of large juvenile nasopharyngeal angiofibromas with intracranial extension is controversial. We review our experience since 1980 with eighteen patients with juvenile nasopharyngeal angiofibroma. A diagnostic and treatment approach consisting of preoperative magnetic resonance imaging, embolization of feeding branches from the external carotid artery, and attempted complete resection was used in seven patients with intracranial disease since 1987. Serial magnetic resonance images were used for followup. Intracranial disease that was persistent or recurrent and demonstrated subsequent growth was irradiated (35 to 45 cGy). Extracranial tumor recurrences were reexcised. We advocate this approach as a safe and effective alternative to primary irradiation and its sequelae.

Innovative Approach to Surgical Treatment for Locally Advanced Cancer of Paranasal Sinus and Nasal Cavity

2021 ◽  
Vol 76 (3) ◽  
pp. 317-323
Author(s):  
Oleg I. Kit ◽  
Igor V. Reshetov ◽  
Marina A. Engibaryan
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Control Group

Background. Despite the rapid oncology development, the problem of surgical treatment for locally advanced tumors of the paranasal sinus and nasal cavity is still relevant. The search and development of ways to improve the surgical approach, including modern endovascular methods, appears necessary. Aims development and evaluation of the effectiveness of an innovative approach to the surgical treatment of malignant tumors of the nasal cavity and paranasal sinus with superselective intra-arterial embolization as a preparatory stage. Materials and methods. The study is based on the treatment outcomes of 52 patients with cancer of the nasal cavity and paranasal sinus. The main group included 21 patients receiving treatment with our developed approach including preoperative superselective intra-arterial embolization as a preparatory stage for surgical treatment. The control group included 31 patients receiving standard surgical treatment with traditional ligation of the external carotid artery at the first stage. Estimation of the amount of intraoperative blood loss with gravimetric analysis was considered the primary endpoint of the study. Post-embolization syndrome manifestations were analyzed by evaluating the pain intensity with a visual analogue scale and thermometry. Results. Intraoperative blood loss in patients of the main group varied from 100 to 400 ml, being on average 231.9100.58 ml. In the control group, the blood loss varied from 300 ml to 1000 ml, on average 630.97190.23. The data analysis proved demonstratively the effectiveness of the developed approach to surgical treatment of locally advanced tumors of the nasal cavity and paranasal sinus, since it statistically significantly reduced the amount of intoperative blood loss (p 0.005). Conclusions. Our developed approach to the treatment for malignant tumors of the paranasal sinus and nasal cavity optimized the results of surgical treatment and statistically significantly reduced the amount of intoperative blood loss, compared to the traditional ligation of the external carotid artery, from 630.97190.23 to 231.9100.58 ml (p 0.005), with minimal manifestations of post-embolization syndrome.

scholarly journals Geometric Alopecia after Preoperative Angioembolization of Juvenile Nasopharyngeal Angiofibroma

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0048 ◽  
Author(s):  
Alejandro Vazquez ◽  
Pratik A. Shukla ◽  
Osamah J. Choudhry ◽  
Chirag D. Gandhi ◽  
James K. Liu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Radiation Exposure ◽  
Skull Base ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma ◽  
Intraoperative Bleeding

Resection of a juvenile nasopharyngeal angiofibroma (JNA) is challenging because of high intraoperative blood loss secondary to the tumor's well-developed vascularity. Endoscopic sinus and skull base surgeons commonly collaborate with neurointerventionalists to embolize these tumors before resection in an attempt to reduce the vascular supply and intraoperative bleeding. However, angioembolization can be associated with significant complications. Geometric alopecia from angioembolization of JNA has not been previously reported in the otolaryngologic literature. In this study, we discuss geometric alopecia from radiation exposure during preoperative angioembolization of a JNA.

scholarly journals Magnetic resonance imaging in evaluation of juvenile nasopharyngeal angiofibroma in term of its diagnosis and pattern of spread

2019 ◽  
Vol 7 (5) ◽  
pp. 1846
Author(s):  
Puran . ◽  
Narendra Kumar Kardam
Keyword(s):  
Surgical Excision ◽  
External Carotid Artery ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Mri Findings ◽  
Contrast Administration ◽  
Nasopharyngeal Angiofibroma ◽  
Signal Void ◽  
Mri Diagnosis ◽  
Age Range

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a tumor that shows a predictable spreading pattern. This study showed the characteristic MRI findings and its pattern of spread of JNA for diagnosis.Methods: This study consisted of 6 cases of JNA for diagnosis and pattern of spreading by using MRI as modality of choice.Results: The total patients included in study were 6 with age range from 9-20 years and all were male. The classification system used in the study was Radkowski and Onerci system. The tumor showed isointensity to muscle and hyperintensity on T1 and T2 sequences respectively on MR imaging. All lesions had internal signal void regions and showed intense enhancement after IV contrast administration. Diffusion restriction was not an associated features however high values of ADC were noted. The MR angiography of three patients showed blood supply of tumor was mainly from the internal maxillary branch of external carotid artery. The treatment was surgical excision of tumor which was decided on MRI Diagnosis and pattern of Extension described in Radiological report.Conclusions: MRI is a modality of choice for diagnosis and extension of JNA based on clinical and radiological findings, without performing a biopsy.

scholarly journals The safety and efficacy of preoperative embolization of meningioma with N-butyl cyanoacrylate

2015 ◽  
Vol 21 (5) ◽  
pp. 624-630 ◽  
Author(s):  
Hideaki Ishihara ◽  
Shoichiro Ishihara ◽  
Jun Niimi ◽  
Hiroaki Neki ◽  
Yoshiaki Kakehi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Blood Loss ◽  
Tumor Volume ◽  
Volume Ratio ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Safety And Efficacy ◽  
Injection Speed ◽  
Intratumoral Bleeding

Objective Preoperative embolization of meningioma is commonly performed; however, there is no consensus on the best embolic material to reduce intraoperative blood loss and surgery time. Method We retrospectively assessed the safety and efficacy of 56 cases of preoperative embolization of the middle meningeal artery with N-butyl cyanoacrylate (NBCA) in 105 cases of surgery for meningioma. We also defined a blood loss to tumor volume ratio to compensate for bias caused by tumor volume, and analyzed limited cases (the embolized group n = 52, the non-embolized group n = 21) of the convexity, the parasagittal region, the falx, and the sphenoidal ridge. Result The blood loss to tumor volume ratio was significantly less in the embolized group ( p < 0.007). Preoperative embolization could be useful for cases with the external carotid artery as the dominant feeder vessel ( p < 0.02); however, the efficacy decreased for cases with an internal carotid artery feeder. Transient complications occurred in four cases (hemiparesis secondary to edema: two cases; intratumoral bleeding: one case; trigeminal nerve disorder: one case). The cases that showed a postoperative increase in edema or intratumoral bleeding were large tumors with the early filling of veins. For such cases, surgeons should pay close attention to slow injection speed and higher NBCA viscosity, not to cause the occlusion of draining vessels. Conclusion Tumor embolization with NBCA can be safely performed, and the procedure significantly reduces intraoperative blood loss.

scholarly journals Comparison of complete and near-complete endovascular embolization of hypervascular spine tumors with partial embolization

2020 ◽  
Vol 33 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Erick M. Westbroek ◽  
Zach Pennington ◽  
A. Karim Ahmed ◽  
Yuanxuan Xia ◽  
Christine Boone ◽  
...  
Keyword(s):  
Blood Loss ◽  
Endovascular Embolization ◽  
Critical Threshold ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Spine Tumors ◽  
Average Blood Loss ◽  
Significant Difference ◽  
Post Hoc ◽  
One Way Anova

OBJECTIVEPreoperative endovascular embolization of hypervascular spine tumors can reduce intraoperative blood loss. The extent to which subtotal embolization reduces blood loss has not been clearly established. This study aimed to elucidate a relationship between the extent of preoperative embolization and intraoperative blood loss.METHODSSixty-six patients undergoing preoperative endovascular embolization and subsequent resection of hypervascular spine tumors were retrospectively reviewed. Patients were divided into 3 groups: complete embolization (n = 22), near-complete embolization (≥ 90% but < 100%; n = 22), and partial embolization (< 90%; n = 22). Intraoperative blood loss was compared between groups using one-way ANOVA with post hoc comparisons between groups.RESULTSThe average blood loss in the complete embolization group was 1625 mL. The near-complete embolization group had an average blood loss of 2021 mL in surgery. Partial embolization was associated with a mean blood loss of 4009 mL. On one-way ANOVA, significant differences were seen across groups (F-ratio = 6.81, p = 0.002). Significant differences in intraoperative blood loss were also seen between patients undergoing complete and partial embolization (p = 0.001) and those undergoing near-complete and partial embolization (p = 0.006). Pairwise testing showed no significant difference between complete and near-complete embolization (p = 0.57). Analysis of a combined group of complete and near-complete embolization also showed a significantly decreased blood loss compared with partial embolization (p < 0.001). Patient age, tumor size, preoperative coagulation parameters, and preoperative platelet count were not significantly associated with blood loss.CONCLUSIONSPreoperative endovascular embolization is associated with decreased intraoperative blood loss. In this series, blood loss was significantly less in surgeries for tumors in which preoperative complete or near-complete embolization was achieved than in tumors in which preoperative embolization resulted in less than 90% reduction of tumor vascular blush. These findings suggest that there may be a critical threshold of efficacy that should be the goal of preoperative embolization.

Sign in / Sign up

Export Citation Format

Share Document