The Role of Endovascular Preoperative Embolization In The Management of Juvenile Nasopharyngeal Angiofibroma

Abstract

Juvenile nasopharyngeal angiofiroma is the most common benign neoplasm of the nasopharynx primarily affecting young adolescent males. It represent less than 0.5% of head and neck tumors.

Diagnosis of the tumor is usually based on a careful clinical assessment and nasal endoscopic examination in addition to findings on cross sectional (CT and MRI) imaging.

Surgery is usually the treatment of choice whenever possible ,yet it may be challenging and can be limited in some cases due to the risk of profuse intraoperative bleeding and the size and extension of the tumor and here come the rule of adjuvant therapy such as preoperative embolization either via endovascular or percutaneous approach.

A series of retrospective studies over the last few years consistently shows benefits of endovascular preoperative embolization for hypervascular head and neck tumors generally ,and juvenile nasopharyngeal angiofibroma especially.

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Conclusion and summary

The indications for tumor embolization include the following: to control surgically inaccessible arterial feeders; to decrease surgical morbidity by reducing blood loss; to shorten the operative procedure time; to increase the chances of complete surgical resection; to decrease risk of damage to adjacent normal tissue; and to allow better observation of the surgical field with decreased overall surgical complication.

A good understanding of the angioarchitecture of head and neck tumors and neurovascular anastomoses plays an important role in diagnosis and treatment planning.

Superselective catheterization of feeding artery is extremely important for safe embolization and to avoid possibility of escape of embolizing material into a dangerous intracranial anastomosis.

The ideal timing for surgical resection is ranging from 48 – 72 h in our study. The effects of embolization will depend on the embolic agent used in the procedure.

The operating surgeons usually reported minimal or no bleeding from the tumor bed in most cases with preoperative embolization, which greatly improved

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Conclusion and summary

resection time, intraoperative blood loss, and visualization

of the lesion margins.

To sum up; preoperative embolization of nasopharyngeal angiofibroma proved to be safe and improves the chance of complete removal during surgery with minimal blood loss.