Juvenile nasopharyngeal angiofibromas: A study of recurrence pattern and role of pre-Operative embolization - ‘a decade’S experience’

Shenoy, Ashok M.; Grover, Namita; Janardhan, Nara; NJayakumar, P; Hegde, Thimappa; S, Satish

doi:10.1007/bf02993742

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…The 2 most common surgical complications were palatal fistula (6 cases) and trismus (4 cases), which occurred in open cases (Table 6). 19,23,25 …”

Section: Resultsmentioning

confidence: 99%

“…GTR was reported in all studies and achieved in 376 patients (90.6%). The included studies had wide heterogeneity in data reporting and did not include subgroup analysis based on embolized versus nonembolized 20 16 (12)(13)(14)(15)(16)(17)(18)(19)(20) 12 males Radkowski: IB (1), IIA (2), IIB (4), IIC (1), IIIA (4) El-Banhawy et al 21 15.5 (8-20) 15 males Andrews-Fisch: IIIa (4), IIIb (11) Hofmann et al 22 17 (13-24) 21 males Andrews-Fisch: I (1), II (14), IIN (1), IIIa (5) Yiotakis et al 23 14.9 (12-18) 20 males Radkowski: Ia (3), Ib (3), IIa (3), IIb (8), IIc (3) Nicolai et al 24 17 46 males Andrews-Fisch: I (5), II (24), IIIa (14), IIIb (3) López et al 25 16 (11)(12)(13)(14)(15)(16)(17)(18) 47 males; 1 female Andrews-Fisch: I (1), II (12), IIIa (13), IIIb (14), IVa (7), IVb (1) Lv et al 9 16 (9-24) 22 males Radkowski: IIc (12), IIIa (5), IIIb (5) Shah et al 26 16 (10-21) 15 males Andrews-Fisch: IIIa (10), IIIb (5) Mujtaba Khan et al 27 16.2 (9-24) 30 males Andrews-Fisch: I (4), II (15), IIa (2), IIIa (7), IIIb (2) Overdevest et al 6 16.7 (7-33) 26 males Radkowski: Ib (3), IIa (5), IIb (4), IIc (5), IIIa (7), IIIb (2) Llorente and López 28 17 (8-39) 30 males; 1 female Radkowski: I (1), IIA (5), IIB (9), IIC (4), IIIA…”

Section: Surgical Outcomes and Tumor Recurrencementioning

confidence: 99%

“…The 2 most common surgical complications were palatal fistula (6 cases) and trismus (4 cases), which occurred in open cases (Table 6). 19,23,25 The follow-up period among all studies ranged from 3 to 266 months, with only 9/14 studies reporting a mean follow-up. The rate of disease recurrence was pooled in a sample of 415 patients, with a proportion of 6.30% (95% CI: 3.01-10.69).…”

Section: Surgical Outcomes and Tumor Recurrencementioning

confidence: 99%

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Preoperative Embolization Techniques in the Treatment of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review

Kothari

Linker

Tham

et al. 2023

Otolaryngol.--head neck surg.

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ObjectivePreoperative embolization has proven beneficial in the surgical treatment of juvenile nasopharyngeal angiofibromas (JNA). However, the consensus for the best embolization practices remains unclear. This systematic review seeks to characterize the reporting of embolization protocols throughout the literature and to compare differences in surgical outcomes.Data SourcesPubMed, Embase, and Scopus.Review MethodsStudies investigating embolization in the treatment of JNA from 2002 to 2021 were selected from defined inclusion criteria. All studies underwent a 2‐stage blinded screening, extraction, and appraisal process. Embolization material, time to surgery, and embolization route were compared. Embolization complications, surgical complications, and rate of recurrence were pooled.ResultsOf 854 studies, 14 retrospective studies with 415 patients met the criteria for inclusion. A total of 354 patients underwent preoperative embolization. A total of 330 patients (93.2%) underwent transarterial embolization (TAE) and 24 patients had a combination of direct puncture embolization and TAE. Polyvinyl alcohol particles were the most used embolization material (n = 264, 80.0%). The most common reported time to surgery was 24 to 48 hours (n = 8, 57.1%). Pooled results showed an embolization complication proportion of 3.16% (95% confidence interval [CI]: 0.96‐6.60) (n = 354), a surgical complication proportion of 4.96% (95% CI: 1.90‐9.37) (n = 415), and a recurrence proportion of 6.30% (95% CI: 3.01‐10.69) (n = 415).ConclusionThe current data on JNA embolization parameters and their effect on surgical outcomes remains too heterogenous to provide expert recommendations. Future studies should use uniform reporting to allow for more robust comparisons of embolization parameters, which, in turn, may lead to optimized patient outcomes.

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“…The 2 most common surgical complications were palatal fistula (6 cases) and trismus (4 cases), which occurred in open cases (Table 6). 19,23,25 …”

Section: Resultsmentioning

confidence: 99%

Section: Surgical Outcomes and Tumor Recurrencementioning

confidence: 99%

Section: Surgical Outcomes and Tumor Recurrencementioning

confidence: 99%

See 1 more Smart Citation

Preoperative Embolization Techniques in the Treatment of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review

Kothari

Linker

Tham

et al. 2023

Otolaryngol.--head neck surg.

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“…Overall, the literature supports the use of PPE as a surgical adjunct. PPE significantly decreases operative blood loss (385 vs. 1,215 mL p < 0.001) and operative (205 vs. 266 min p < 0.064) compared to non-embolized controls [69], a finding echoed in multiple studies [70][71][72]. Gelfoam [70,71,73], PVA particles with [74] and without coils [71], and liquid embolics [75] are commonly used agents.…”

Section: Juvenile Nasopharyngeal Angiofibromamentioning

confidence: 93%

“…PPE significantly decreases operative blood loss (385 vs. 1,215 mL p < 0.001) and operative time (205 vs. 266 min p < 0.064) compared to non-embolized controls [69], a finding echoed in multiple studies [70–72]. Gelfoam [70, 71, 73], PVA particles with [74] and without coils [71], and liquid embolics [75] are commonly used agents. More aggressive techniques such as balloon-assisted occlusion of the ICA to embolize inferolateral trunk pedicles can achieve high degrees of tumor devascularization [76] Figure 6 illustrates the use of ethylene vinyl alcohol copolymer in PPE of a right-sided JNA.…”

Section: Juvenile Nasopharyngeal Angiofibromamentioning

confidence: 99%

Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors

Huisman,

Patel,

Kralik

et al. 2023

Pediatr Neurosurg

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Background: Neuroimaging has evolved from anatomical imaging toward a multi-modality comprehensive anatomical and functional imaging in the past decades, important functional data like perfusion-weighted imaging, permeability imaging, diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI), tractography, metabolic imaging, connectomics, event-related functional imaging, resting state functional imaging, and much more is now being offered. Summary: Precision diagnostics has proven to be essential for precision treatment. Many minimal invasive techniques have been developed, taking advantage of digital subtraction angiography and interventional neuroradiology. Furthermore, intraoperative CT and/or MRI and more recently MR-guided focused ultrasound have complemented the diagnostic and therapeutic armamentarium. Key Messages: In the current manuscript, we discuss standard imaging sequences including advanced techniques like DWI, DTI, susceptibility-weighted imaging, and 1H magnetic resonance spectroscopy, various perfusion weighted imaging approaches including arterial spin labeling, dynamic contrast enhanced imaging, and dynamic susceptibility contrast imaging. Pre-, intra, and postoperative surgical imaging including visualize imaging will be discussed. The value of connectomics will be presented for its value in neuro-oncology. Minimal invasive therapeutic possibilities of interventional neuroradiology and image-guided laser ablation and MR-guided high-intensity-focused ultrasound will be presented for treatment of pediatric brain and spinal cord tumors. Finally, a comprehensive review of spinal cord tumors and matching neuropathology has been included.

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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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Juvenile nasopharyngeal angiofibromas: A study of recurrence pattern and role of pre-Operative embolization - ‘a decade’S experience’

Cited by 5 publications

References 10 publications

Preoperative Embolization Techniques in the Treatment of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review

Preoperative Embolization Techniques in the Treatment of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review

Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors

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

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