Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

Case of IV Stage Juvenile Nasopharyngeal Angiofibroma Presurgically Treated with a Single ECA Stop-Flow Embolization Technique Using Onyx 18

“…The most widely used embolic agents are polyvinyl alcohol (PVA) [ 3 ], NBCNA (n-Butyl cyanoacrylate), and microparticles/microcoils of different dimensions. However, the embolization with particulate embolic agents is frequently incomplete and time-consuming due to the numerous small arterial feeders, some of which may be inaccessible due to size, tortuosity, or derivation from the internal carotid artery (ICA).…”

“…The advantages of liquid embolic agents are the optimal visualization and the deep penetration and definitive and superselective embolization compared to coils and microparticles/microcoils which are associated also with nontarget embolization. The NBCNA (n-Butyl cyanoacrylate) is more similar to liquid agents, but it has more complex handling [ 3 , 4 ].…”

“…Juvenile nasopharyngeal angiofibroma (JNA) is a rare entity, comprising about 0.05% of all tumors of the head and the neck [ 1 – 3 ], found primarily in young boys. It is histologically considered a highly vascularized benign tumor, originating in the sphenopalatine region, but it is characterized by aggressive behavior with a tendency for rapid growth and invasion of neighboring structures, as well as by recurrence after intervention [ 4 ].…”

Pediatric Interventional Neuroradiology

“…However, because of the highly vascular nature of the lesion, preoperative embolization is usually needed to reduce intraoperative bleeding and surgical complications. 43 Embolization is usually performed of the sphenopalatine branch of the internal maxillary artery using Gelfoam or polyvinyl alcohol particles ( Fig. 10 ).…”

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

“…[9][10][11] Studies have described the use of several embolic materials, including polyvinyl alcohol (PVA) particles, embolic coils, Gelfoam (Pfizer), cyanoacrylate, and Onyx (Medtronic). 9,[12][13][14][15] To date, there are no definitive analyses that demonstrate the superiority of any single embolization technique, material, or timeframe prior to surgery. As a result, institutional protocols based on the experience of the treatment team tend to dominate decision-making.…”