Abstract
Objective
This study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE).
Methods
The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20–25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE.
Results
The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion.
Conclusions
The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gullane PJ, Davidson J, O’Dwyer T, Forte V (1992) Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 102:928–933
Radkowski D, Mcgill T, Healy GB et al (1996) Angiofibroma. Changes in staging and treatment. Arch Otolaryngol Head Neck Surg 122(2):122–129
Mokhtar M, Badrawy R, Osman M (1972) The juvenile angiofibroma of the nasopharynx. J Egypt Med Assoc 55(8):692–703
Moulin G, Chagnaud C, Gras R et al (1995) Juvenile nasopharyngeal angiofibroma: comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovasc Interv Radiol 18:158–161
Paris J, Guelfucci B, Moulin G et al (2001) Diagnosis and treatment of juvenile nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 258:120–124
Sokoloff J, Wickbom I, McDonald D, Brahme F, Goergen TC, Goldberger LE (1974) Therapeutic percutaneous embolization in intractable epistaxis. Radiology 111:285–287
Tranbahuy P, Borsik M, Herman P et al (1994) Direct intratumoral embolization of juvenile angiofibroma. Am J Otolaryngol 15(6):429–435
Casasco A, Houdart E, Biondi A et al (1999) Major complications of percutaneous embolization of skull-base tumors. Am J Neuroradiol 20(1):179–181
Lehmann M, Ulrich S, Reineke U et al (2010) Intratumoral onyx embolisation in the management of juvenile nasopharyngeal angiofibroma. HNO 58:853–857
Herman B, Bublik M, Ruiz J et al (2011) Endoscopic embolization with onyx prior to resection of JNA: a new approach. Int J Ped Otorhinolaryngol 75:53–56
Antonelli AR, Cappiello J, Di Lorenzo D et al (1987) Diagnosis, staging, and treatment of juvenile nasopharyngeal angiofibroma (JNA). Laryngoscope 97:1319–1325
Herman P, Lot G, Chapot R et al (1999) Long-term follow-up of juvenile nasopharyngeal angiofibromas: analysis of recurrences. Laryngoscope 109:140–147
Khalifa MA, Ragab SM (2008) Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension. Int J Pediatr Otorhinolaryngol 72(12):1855–1860
Midilli R, Karci B, Akyildiz S (2009) Juvenile nasopharyngeal angiofibroma: analysis of 42 cases and important aspects of endoscopic approach. Int J Pediatr Otorhinolaryngol 73:401–408
Pryor SG, Moore EJ, Kasperbauer JL (2005) Endoscopic versus traditional approaches for excision of juvenile nasopharyngeal angiofibroma. Laryngoscope 115:1201–1207
Roberson GH, Biller H, Sessions DG et al (1972) Presurgical internal maxillary artery embolization in juvenile angiofibroma. Laryngoscope 82(8):1524–1532
Li JR, Qian J, Shan XZ et al (1998) Evaluation of the effectiveness of preoperative embolization in surgery for nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 255:430–432
Nicolai P, Berlucchi M, Tomenzoli D et al (2003) Endoscopic surgery for juvenile angiofibroma: when and how. Laryngoscope 113:775–782
Petruson K, Rodriguez-Catarino M, Petruson B et al (2002) JNA: long-term results in preoperative embolized and non-embolized patients. Acta Otolaryngol 122:96–100
Gore P, Theodore N, Brasiliense L, Kim LJ, Garrett M, Nakaji P et al (2008) The utility of onyx for preoperative embolization of cranial and spinal tumors. Neurosurgery 62:1204–1211
Elhammady MS, Wolfe SQ, Ashour R et al (2010) Safety and efficacy of vascular tumor embolization using onyx: is angiographic devascularization sufficient? J Neurosurg 112:1039–1045
Jahan R, Murayama Y, Gobin YP et al (2001) Embolization of arteriovenous malformations with Onyx: clinic pathological experience in 23 patients. Neurosurgery 48:984–995
Liu L, Wang R, Huang D et al (2002) Analysis of intra-operative bleeding and recurrence of JNA. Clin Otolaryngol Allied Sci 27:536–540
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Lv, Mm., Fan, Xd., Su, Lx. et al. Preoperative Direct Puncture Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma in Combination with Transarterial Embolization: An Analysis of 22 Consecutive Patients. Cardiovasc Intervent Radiol 36, 111–117 (2013). https://doi.org/10.1007/s00270-012-0404-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-012-0404-2