Importance of pre-operative embolization in the surgery of nasopharyngeal angiofibroma

Desarda, KK; Pande,; Bora, Mahesh

doi:10.1007/bf02996767

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…Martins et al used endoscopic approach when average blood loss was 300 ml [9]. Transpalatal approach have documented about 10 units of blood transfusion [10].…”

Section: Discussionmentioning

confidence: 99%

Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective

Gupta

Agarwal

2016

Indian J Otolaryngol Head Neck Surg

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Juvenile angiofibroma is a rare, highly vascular, histologically benign but locally invasive tumour, affecting predominantly male adolescents. To describe our experience in diagnosis of angiofibroma and treatment by combined endoscopic and transpalatal route. We analysed a case series of 50 patients of nasopharyngeal angiofibroma in Fisch stages I and II who presented at our institute during a period of four years 2011-2014, their clinical presentation, their treatment by combined transpalatal and endoscopic approach, intraoperative and post operative course, complications and tumour recurrence. Patients were aged 8-26 years. All patients were treated surgically by combined approach endoscopic and transpalatal. The mean operation time was 90 min, and the mean bleeding volume was 300 ml. Only 8 % patients came with recurrence and only 10 % came with palatal perforation (fistula formation). With gratifying results we advocate this novel technique for the treatment of early to intermediate JNA.

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“…Martins et al used endoscopic approach when average blood loss was 300 ml [9]. Transpalatal approach have documented about 10 units of blood transfusion [10].…”

Section: Discussionmentioning

confidence: 99%

Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective

Gupta

Agarwal

2016

Indian J Otolaryngol Head Neck Surg

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“…Its main disadvantages are a limited access, restricted visibility, difficulty in controlling the bleeding and tumors must be delivered through the mouth. If used in conjunction with preoperative embolization 14 to reduce the vascularity of the tumor, this approach can prove to be far superior to others.…”

Section: Discussionmentioning

confidence: 99%

Juvenile Nasopharyngeal Angiofibroma: Correlating Histology, Surgical Approach and Blood Loss

Aiyer¹,

Gupta²,

Jagtap³

et al. 2015

An International Journal Clinical Rhinology

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Juvenile nasopharyngeal angiofibroma (JNA) is locally destructive benign vascular tumor for which surgical excision has always been the treatment of choice, in spite of the availability of various other treatment modalities. Complete removal at the maiden attempt has always been the key to a successful outcome. Recurrences (or rather residuals) discourage both the surgeon and patient. This prospective study was carried out in the Department of Otorhinolaryngology, Sir Sayajirao General Hospital, Vadodara, Gujarat, between August 2002 and 2015. We have studied 28 patients with JNA for growth patterns, histological characteristics and to compare various surgical modalities. Besides other investigations a detailed histological examination of the tumor was performed which suggested that as the tumor ages, the stroma predominates and the vessels are compressed into slits. In actively growing tumor the vascular component predominates. The percentage of open vascular channels is directly proportional to the bleeding while the intervascular fibrosis is inversely related. Surgical excision of JNA is the preferred modality of treatment. Surgical approach is sometimes the most tricky decision. Choosing the right approach is akin to walking on the thin rope with adequate exposure on one side and postoperative scar on the other. How to cite this article Thapar T, Gupta RR, Jagtap PJ, Aiyer RG. Juvenile Nasopharyngeal Angiofibroma: Correlating Histology, Surgical Approach and Blood Loss. Clin Rhinol An Int J 2015;8(2):47-52.

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Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta‐Analysis

et al. 2023

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Objective To compare outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non‐embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE). Data Sources Per PRISMA guidelines, PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched for publications prior to or in 2021. Materials and Methods Original English manuscripts investigating the resection of JNA with and without preoperative embolization were included. Embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Risk of bias was assessed by the Risk of Bias in Non‐randomized Studies—of Interventions method. Results There were 61 studies with 917 patients included. Preoperative embolization was performed in 79.3% of patients. Of those embolized, 75.8% (N = 551) underwent TAE and 15.8% (N = 115) underwent DPE. JNA recurrence in embolized patients was lower than in non‐embolized patients (9.3% vs. 14.4%; odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.35, 1.06). DPE resulted in lower rates of disease recurrence (0% vs. 9.5%; OR: 0.066, 95% CI: 0.016, 0.272) and complications (1.8% vs. 21.9%; OR: 0.07, 95% CI: 0.02, 0.3) than TAE. A random effects Bayesian model was performed to analyze the difference in mean blood loss in 6 studies that included both embolized and non‐embolized patients. This analysis showed a mean reduction in blood loss of 798 mL in the embolized group. Conclusions We found embolization decreases blood loss in JNA resection. DPE led to improved recurrence and complication rates when compared to TAE, but future prospective studies are needed to further evaluate which embolization technique can optimize outcomes in JNA. Level of Evidence NA Laryngoscope, 133:1529–1539, 2023

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Importance of pre-operative embolization in the surgery of nasopharyngeal angiofibroma

Cited by 5 publications

References 4 publications

Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective

Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective

Juvenile Nasopharyngeal Angiofibroma: Correlating Histology, Surgical Approach and Blood Loss

Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta‐Analysis

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