Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary?

Liu, Qiang; Xia, Zhipeng; Ren, Hong; Pan, Yaokun; Xue, Kai; Liu, Quan; Sun, Xicai; Li, Houyong; Sha, Yan; Yu, Hongmeng; Wang, Dehui

doi:10.1007/s00270-023-03483-1

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…1,6,13,16,20,21 Recent technological advances have made this procedure safer and more effective, justifying the continuation of this practice. 1,18,28 Nevertheless, data regarding transoperative blood loss after preoperative embolization in JNA resection surgery is controversial. Although various studies show its effectiveness in reducing blood loss and other advantages, 1,6,12,21,28,34,36 other studies, including a systematic review, fail to demonstrate that intraoperative bleeding in embolized patients is statistically lower when compared with nonembolized patients.…”

Section: Discussionmentioning

confidence: 99%

“…1,18,28 Nevertheless, data regarding transoperative blood loss after preoperative embolization in JNA resection surgery is controversial. Although various studies show its effectiveness in reducing blood loss and other advantages, 1,6,12,21,28,34,36 other studies, including a systematic review, fail to demonstrate that intraoperative bleeding in embolized patients is statistically lower when compared with nonembolized patients. 45,46 It is worth mentioning that the data in the current literature is not ideal to draw conclusions, since no randomized controlled trials have been conducted.…”

Section: Discussionmentioning

confidence: 99%

“…Blood supply to JNAs can be highly variable, with collaboration of multiple branches of the external carotid artery (ECA), contralateral ECA branches, and small branches arising from the internal carotid artery (ICA). 27,28 After thorough evaluation of clinical, imaging, and intraoperative data, we believe that the ICA system rarely contributes to tumor nutrition. Dilation of vessels that belong to the ICA system can be explained due to high blood flow inside the tumor, which dilates the regional vessels.…”

Section: Discussionmentioning

confidence: 99%

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Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases

Felippu,

Fontes,

Felippu

et al. 2024

Int Arch Otorhinolaryngol

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Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascularized tumor that affects almost exclusively male adolescents. Surgery is the treatment of choice for JNA. Objectives The present study is a 42-year retrospective review of a series of JNA cases treated surgically without previous embolization. Methods The present is a retrospective, descriptive study based on medical records of 96 patients with JNA who underwent microscopic or endoscopic excision without previous embolization from 1978 to 2020 in a single institution. The patients were categorized according to the Andrews et al. stage, and data were collected on age, gender, tumor staging, surgical approach, affected side, and outcome. Results All patients were male, with an average age of 17 years. The predominant tumor stage consisted of type II, with 52.1%. A total of 33.3% of the patients were submitted to the microscopic technique and 66.7%, to the endonasal technique. The rate of intraoperative blood transfusion was of 17.7%. Conclusion The present study reinforces that resection of JNA in various stages is viable without previous artery embolization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases

Felippu,

Fontes,

Felippu

et al. 2024

Int Arch Otorhinolaryngol

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“…Surgical excision, the gold standard treatment for JNA, is highly challenging due to its high vascularity and local aggressiveness [ 2 ]. These tumors have an intricate vascular supply, deriving blood from both the external and internal carotid arteries [ 3 ]. Furthermore, JNAs exhibit aggressive invasion into neighboring structures, complicating surgical resection.…”

Section: Introductionmentioning

confidence: 99%

Total Endoscopic or Endoscope-Assisted Excision of Non-embolized Advanced Juvenile Nasopharyngeal Angiofibroma: A Clinical Case Series

Liaqat,

Din,

Ul Haq

et al. 2024

Cureus

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Background Surgical excision is the primary treatment for juvenile nasopharyngeal angiofibroma (JNA), but this procedure is challenging due to its high vascularity and local aggressiveness. Moreover, preoperative embolization is a subject of debate. Objective The objective of this study is to assess the efficacy, safety, and feasibility of endoscope-assisted excision as a surgical intervention for non-embolized advanced JNA. Materials and methods This case series involved six male patients (mean age: 16 years) with JNA, classified as stages Ⅱc to Ⅲb according to the Radkowski classification. None underwent preoperative embolization. Results Two stage Ⅱc cases underwent total endoscopic endonasal excision. One patient with stage Ⅲa and another with stage Ⅲb underwent surgery via an endoscope-assisted sublabial approach. Two patients, one with stage Ⅱc JNA and another with Ⅲb, underwent a two-stage procedure. Postoperative CT scans showed no residual disease at the six-month mark. On average, each procedure required 1.5 units of blood transfusion. One patient experienced intraoperative bleeding, whereas the remaining patients were free of any major complications. The mean operation duration was 175 minutes per procedure. The mean length of stay at the hospital was 3.75 days per procedure. Conclusion Endoscope-assisted or purely endoscopic approaches can be safely and effectively employed for the complete excision of non-embolized advanced JNAs.

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Commentary on: Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary?

Salman

2023

Cardiovasc Intervent Radiol

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Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary?

Cited by 3 publications

References 14 publications

Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases

Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases

Total Endoscopic or Endoscope-Assisted Excision of Non-embolized Advanced Juvenile Nasopharyngeal Angiofibroma: A Clinical Case Series

Commentary on: Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary?

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