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

Abstract

ObjectivePreoperative embolization has proven beneficial in the surgical treatment of juvenile nasopharyngeal angiofibromas (JNA). However, the consensus for the best embolization practices remains unclear. This systematic review seeks to characterize the reporting of embolization protocols throughout the literature and to compare differences in surgical outcomes.Data SourcesPubMed, Embase, and Scopus.Review MethodsStudies investigating embolization in the treatment of JNA from 2002 to 2021 were selected from defined inclusion criteria. All studies underwent a 2‐stage blinded screening, extraction, and appraisal process. Embolization material, time to surgery, and embolization route were compared. Embolization complications, surgical complications, and rate of recurrence were pooled.ResultsOf 854 studies, 14 retrospective studies with 415 patients met the criteria for inclusion. A total of 354 patients underwent preoperative embolization. A total of 330 patients (93.2%) underwent transarterial embolization (TAE) and 24 patients had a combination of direct puncture embolization and TAE. Polyvinyl alcohol particles were the most used embolization material (n = 264, 80.0%). The most common reported time to surgery was 24 to 48 hours (n = 8, 57.1%). Pooled results showed an embolization complication proportion of 3.16% (95% confidence interval [CI]: 0.96‐6.60) (n = 354), a surgical complication proportion of 4.96% (95% CI: 1.90‐9.37) (n = 415), and a recurrence proportion of 6.30% (95% CI: 3.01‐10.69) (n = 415).ConclusionThe current data on JNA embolization parameters and their effect on surgical outcomes remains too heterogenous to provide expert recommendations. Future studies should use uniform reporting to allow for more robust comparisons of embolization parameters, which, in turn, may lead to optimized patient outcomes.

Multimodal blood loss prevention bundle for endoscopic resection of juvenile nasopharyngeal angiofibroma: A case series

“…Embolisation reduces bleeding to a large extent due to the increased vascularity of the tumour. [ 3 ] However, bleeding encountered during functional endoscopic sinus surgery (FESS) is also from the richly vascularised capillary beds of the sinonasal mucosa. Larger vessels are not usually the cause of bloody fields in FESS.…”

“…[ 1 ] Various techniques like a reverse Trendelenburg position, use of tranexamic acid, control of heart rate (HR) and blood pressure by α-agonists and β-blockers, propofol infusion[ 2 ] and preoperative embolisation have been described to control bleeding during endoscopic nasal surgery. [ 3 ] Few studies have described the anaesthesia management of JNA. [ 4 5 6 7 8 ] However, a bundle approach has not been studied.…”

Combined Direct Tumoral Puncture Embolization with Onyx and Trans‐arterial Embolization for JNA

“…Numerous factors may limit the utility of TAE, and therefore, our technique combining TAE with DAE is safe and may aid in resection. 1,2 Although several studies have demonstrated that DPE is safe and effective, the existing literature is limited, especially in regard to Onyx. Pooled data does not demonstrate a statistically significant benefit.…”

“…There is significant variation regarding embolization practices with a wide range of different techniques described and a limited basis for expert recommendations to guide decision making. 1,2 Direct puncture embolization (DPE) using an elastic polymer comprised of ethylene-vinyl alcohol copolymer or "Onyx" (Medtronic, Minneapolis, Minnesota) has been shown to be a safe and effective technique for vascular tumors. 3 As an embolic agent, Onyx offers advantages over n-Butyl-cyanoacrylate (nBCA), including more controlled delivery time, a slower rate of polymerization, and longer working time.…”

The Role of Preoperative Onyx Embolization by Transnasal Direct Puncture in the Treatment of an Advanced Juvenile Nasopharyngeal Angiofibroma

“…In cases where the tumor has an extensive supply from the internal carotid artery (ICA) branches, endovascular embolization carries a high risk of ischemic complications due to the reflux of microparticles or ethylene-vinyl alcohol copolymer (EVOH). In these situations, direct tumor puncture followed by embolization using EVOH or acrylic glue would presumably be an excellent alternative for promoting total or near-total tumor devascularization [5,[7][8][9][10][11].…”