Radiological findings in angiofibroma

Abstract

Surgery after pre-operative embolization has become the main treatment modality in angiofibroma therapy. As surgical planning is based on precise preoperative tumour evaluation, knowledge of the characteristic growth patterns is of great interest. Analysis of tumour extension and blood supply, as well as methods of controlling intra-operative bleeding, help in determining the appropriate surgical approach. Though benign, angiofibroma demonstrates a locally aggressive nature. This fibrovascular tumour is characterised by typical radiological findings and by predictable growth patterns. The tumour extension and blood supply can be accurately determined by CT, MR imaging and angiography. With classic radiological findings, no pre-operative biopsy is necessary in most angiofibromas. Advances in radiological imaging have contributed to improved surgical planning and tumour resection. The surgeon is able to select the least traumatic approach with secure haemostatic control, which is also critical for avoiding the disturbance of facial skeletal growth in this group of young patients. Embolization, pre-operative autologous donation and the cell saver system for immediate retransfusion of the collected blood after filtration, are important tools for dealing with blood loss in angiofibroma surgery as they minimize homologous blood transfusion.

Freiburg Neuropathology Case Conference: A Patient with Chronic Nasal Obstruction

“…Contrast-enhanced T1-weighted images demonstrated an intense enhancement, and the dynamic MR angiography showed an early blush in the arterial phase, which indicates a highly vascularized tumor and might resemble the capillary blush of the juvenile angiofibroma as seen on conventional angiographic images. The age of the patient and the lacking involvement of the sphenopalatine foramen, however, practically exclude this differential diagnosis [6].…”

Juvenile Angiofibroma: Evolution of Management

“…The growth of the lesion has the peculiar tendency to follow a submucosal plane, growing in the adjacent anatomical sites that offer less resistance and invade the cancellous bone of the basisphenoid. Because of the constant site of origin and the knowledge of tumor behavior in relation to surrounding tissues, spreading patterns of JA are highly predictable [32, 33]. From the pterygopalatine fossa, the tumor grows medially into the nasopharynx, nasal fossa, and eventually towards the contralateral side.…”

“…Some reports [33, 41] have stated that this procedure did not affect perioperative bleeding, although some years later Glad et al [3] observed that embolization provides a 60–70% reduction in intraoperative bleeding, and the need for blood transfusion is required. Although the modification within the lesion induced by the embolization has been indicated as a contributory cause of incomplete excision [42], refinements in the technique and the introduction of new materials have minimized the risk of leaving residual disease.…”

Prominent collagen type VI expression in juvenile angiofibromas

“…Despite being classiWed as benign tumours, JAs often exhibit an aggressive growth pattern with tumour spread through natural Wssures and foramina reaching even intracranial tumour extension (Schick and Kahle 2000). The characteristic features of JAs prompted investigations into a better understanding of the underlying pathogenetic mechanisms.…”