Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta‐Analysis

Abstract

Objective To compare outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non‐embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE). Data Sources Per PRISMA guidelines, PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched for publications prior to or in 2021. Materials and Methods Original English manuscripts investigating the resection of JNA with and without preoperative embolization were included. Embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Risk of bias was assessed by the Risk of Bias in Non‐randomized Studies—of Interventions method. Results There were 61 studies with 917 patients included. Preoperative embolization was performed in 79.3% of patients. Of those embolized, 75.8% (N = 551) underwent TAE and 15.8% (N = 115) underwent DPE. JNA recurrence in embolized patients was lower than in non‐embolized patients (9.3% vs. 14.4%; odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.35, 1.06). DPE resulted in lower rates of disease recurrence (0% vs. 9.5%; OR: 0.066, 95% CI: 0.016, 0.272) and complications (1.8% vs. 21.9%; OR: 0.07, 95% CI: 0.02, 0.3) than TAE. A random effects Bayesian model was performed to analyze the difference in mean blood loss in 6 studies that included both embolized and non‐embolized patients. This analysis showed a mean reduction in blood loss of 798 mL in the embolized group. Conclusions We found embolization decreases blood loss in JNA resection. DPE led to improved recurrence and complication rates when compared to TAE, but future prospective studies are needed to further evaluate which embolization technique can optimize outcomes in JNA. Level of Evidence NA Laryngoscope, 133:1529–1539, 2023

Case of giant juvenile angiofibroma resected by external incision with temporary double balloon occlusion of the internal carotid artery by intraoperative endovascular treatment

“…It is generally accepted that preoperative embolisation of the blood from the ECA decreases intraoperative blood loss during resection of JNA 9…”

“…In addition, in both TAE and DPE, serious complications, such as retinal artery occlusion and cerebral infarction, have been reported with both techniques, suggesting that the risks of embolisation must be considered when determining if the procedure will be performed, regardless of the technique being used 9 12 13…”

Pädiatrische Rhinologie

“…In general, the rate of recurrence in patients with embolized spaceoccupying lesions, regardless of the technique used for embolization, was lower than in cases without pretreatment. Embolization also has a positive effect on surgery time and blood loss [170]. In addition to the positive effects on blood loss and clarity during surgery, the angiography itself naturally depicts the relationships of the vascular architecture.…”

“…Generell war die Rate an Rezidiven bei Patienten mit embolisierten Raumforderungen, egal in welcher Technik die Embolisation erfolgt war, geringer als bei Fällen ohne eine Vorbehandlung. Die Embolisation wirkt sich auch positiv auf die Ope-rationszeit und den Blutverlust aus [170]. Neben den positiven Effekten auf den Blutverlust und die Übersichtlichkeit während der Operation werden bei der Angiografie selbst natürlich auch die Verhältnisse der Gefäßarchitektur dargestellt.…”

Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases

“…11 It affects almost exclusively male adolescents. [1][2][3][4][5][6][7][8][9][10] Although its histological features are benign, it can be locally aggressive and is associated with high persistence and recurrence rates. 11,12 The diagnosis is based on clinical and image evaluation with contrast-enhanced sequences, such as computed tomography (CT) and magnetic resonance imaging (MRI).…”