Vision Loss due to Central Retinal Artery Occlusion Following Embolization in a Case of a Giant Juvenile Nasopharyngeal Angiofibroma

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, vascular, and locally aggressive tumor that arises in the nasal cavity, extending into the nasopharynx and often in to the orbit. It may rarely present to the ophthalmologist with proptosis and optic neuropathy. Preoperative embolization of JNA is done before surgical resection. In this communication, the authors report a rare occurrence of ipsilateral central retinal artery occlusion (CRAO) following embolization with polyvinyl alcohol in a 13-year-old boy with right-sided JNA. Retrospective review of the angiograms pointed out to a suspicious communication between the external carotid artery and the ophthalmic vessels. Pre-embolization detailed study of the angiograms is necessary to avoid such devastating complications. Although rare, vision loss is a possible complication arising from embolization of nasopharyngeal and intracranial tumors, and all patients undergoing these procedures should be informed of the risk of visual loss because it has a lasting impact on the quality of life.

Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas

“…[18] At least three articles have also reported the debilitating complication of retinal artery occlusion and blindness following preoperative embolization for JNA. [212530] The benefit of embolization should, therefore, be carefully balanced against the risk of neurological complications in an otherwise histologically benign tumor.…”

Juvenile Nasopharyngeal Angiofibroma - Our Experience in a Tertiary Hospital

“…Among the eleven embolized patients, the intraoperative blood loss in 4 patients was insignificant and in the rest of patients ranged from 250-700 ml with an average of 450 ml [3][4][5]. Embolization reduced intraoperative blood loss from an average of 950 ml in the non-embolized patients to 380 ml in the embolized patients.…”

“…Serious complications occur in less than two percent of patients. These are usually related to particle reflux, poor technique, or non-visualization of dangerous anastomoses resulting in blindness or irreversible neurologic deficits [4].…”

Angiofibroma nasoseptal: Reporte de un caso y revisión

“…En tumores pequeños, la embo-lización puede ser compleja y la contribución de este procedimiento durante la cirugía es controvertida, dejando la embolización selectiva para los casos en que el beneficio intraoperatorio es claro. La embolización de este tipo de tumores no está exenta de complicaciones, como la embolización incidental de arterias e infartos de territorios adyacentes ubicados en estos lugares 12 . En nuestro caso, decidimos no embolizar la lesión de nuestro paciente para realizar una resección local bajo anestesia general, debido al pequeño tamaño de la lesión.…”