Preoperative Embolization to Improve the Surgical Management and Outcome of Juvenile Nasopharyngeal Angiofibroma (JNA) in a Single Center: 10-Year Experience

Lutz, Jürgen; Holtmannspötter, M.; Flatz, Wilhelm; Meier-Bender, A.; Berghaus, Alexander; Brückmann, H.; Zengel, Pamela

doi:10.1007/s00062-015-0374-2

Cited by 52 publications

(59 citation statements)

References 24 publications

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“…Embolic substances include polyvinyl alcohol (PVA), coils, microparticles, or liquid glue. The ethylene‐vinyl alcohol copolymer Onyx (ev3, Irvine, CA), shows technical advantages enabling deep penetration into the tumor, with more extensive tumor necrosis, embolization of large portions of the tumor via fewer catheterizations, and safe withdrawal of the catheter despite possible substantial reflux . Successful arterial embolization with any of these embolic agents may be limited by vessel tortuosity, vasospasm, or prior loss of the internal maxillary artery or external carotid artery.…”

Section: Introductionmentioning

confidence: 99%

Nasal juvenile angiofibroma: Current perspectives with emphasis on management

et al. 2017

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Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017.

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Section: Introductionmentioning

confidence: 99%

Nasal juvenile angiofibroma: Current perspectives with emphasis on management

et al. 2017

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“…The latter is statistically superior in reducing blood loss, reducing number of transfusions and increasing the number of lesions amenable to endoscopic resection when compared with particulate embolization. 26,27 Additional advantages of Onyx include pigmentation of the tumor, more extensive tumor necrosis, embolization by fewer catheterizations, superior devascularization on angiograms, and no recurrence at follow-up. 27 If the tumor feeding vessels cannot be safely embolized or are inaccessible, then further options include intratumoral embolization and surgical strategies, such as isolation and ligation of the internal maxillary artery, radiofrequency ablation, hypotensive anesthesia, division into vascular segments, diathermy of the sphenopalatine artery, cauterization of the vidian artery (the predominant feeding vessel of the ICA), and staging of surgery.…”

Section: Embolizationmentioning

confidence: 99%

Current Management and Controversies of Juvenile Angiofibromas

Butler¹,

Scholfield²,

Madani³

et al. 2018

International Journal of Head and Neck Surgery

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Juvenile angiofibromas are benign, highly vascular lesions that are found in young male patients with an incidence of approximately 1:150,000. They are thought to arise from a residual vascular plexusin the pterygopalatine fossa at the aperture of the pterygoid canal, as a remnant of the involution of the first branchial arch artery. Juvenile angiofibromas remain challenging to treat. Early staged disease can be adequately treated by endoscopic approaches and with increasing experience, even higher staged disease has been shown to be resectable BACKGROUND Juvenile angiofibromas (JAs) are benign, highly vascular lesions that are found in young male patients in the posterior nose and postnasal space arising from the posterolateral nasopharynx. They represent 0.05% of all head and neck tumors, with an incidence of approximately 1:150,000. 1 Radiological studies have identified their anatomical origin in the pterygopalatine fossa at the aperture of the pterygoid (vidian) canal. 2 They are thought to arise from a residual vascular plexus, as a IJHNS REVIEW ARTICLE

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“…It represents 0.05% to 0.5% of all head and neck tumors. 57 The classic presentation is a unilateral nasopharyngeal mass that results in nasal obstruction and epistaxis. 58 JNA often originates in the area of the sphenopalatine foramen, before progressing into the nose and pterygomaxillary space.…”

Section: Juvenile Nasopharyngeal Angiofibromamentioning

confidence: 99%

“…Surgical access is difficult and may explain the high recurrence rate (26%-46%) with local excision. 57 Transfacial, intraoral (transpalatal, Le Fort I), and endonasal endoscopic techniques have all been described for the surgical removal of JNA. 60 The technique is selected based on location and amount of tissue invasion.…”

Section: Juvenile Nasopharyngeal Angiofibromamentioning

confidence: 99%