Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

Abstract

Objectives This study was aimed to understand the usefulness of transarterial angiography and embolization in management of juvenile nasopharyngeal angiofibroma (JNA) and to apply the information obtained to stage the disease, select appropriate surgical approach, predict intraoperative bleeding, and prognosticate the disease. Design This study represents a retrospective review of the patients of JNA with major focus on transarterial angiography and embolization findings and its clinical and surgical implications. Setting The study conducted at a tertiary-care super-specialty referral center. Participants Forty-two patients who had undergone transarterial angiography and embolization followed by surgery over the period of 5 years from July 2015 till February 2019 were participated in this study. Main Outcome Measures Tumor vascular pattern based on transarterial angiography, staging of the disease based on extent and vascular supply, surgical approach selected, and prognosticating the disease were determined from this study. Conclusion Transarterial angiography with embolization becomes a prudent preoperative investigation for management of JNA. It provides a complete three-dimensional map of the tumor with stage-specific vascular pattern, reduces vascularity of the tumor, and predicts the sites from where bleeding can occur intra operatively. Thus, it helps in choosing the appropriate surgical approach aiding in complete tumor removal with minimal bleeding.

Comparison of External Carotid Ligation and Preope Embolization of Feeding Vessel for Controlling Perop Heamorhage in Angiofibroma Excision

“…These improved radiography techniques have shown that 20% of the tumors showed intracranial extent. Definitive diagnosis was based on angiography which shows the feeding vessel and also aids in its embolization 17 . The characteristic angiographic appearance is a blush that appears on digital subtraction angiogram.…”

The Surgical Strategy of Juvenile Nasopharyngeal Angiofibroma: A Case Report

“…Preoperative arteriography can be safely and effectively used as an adjuvant surgery to embolize the feeding artery before JNA surgical resection [4] . In the present study, preoperative digital subtraction angiography showed contributing vessels from bilateral ECA and involvement of right ICA.…”

Pädiatrische Rhinologie

“…In addition to the positive effects on blood loss and clarity during surgery, the angiography itself naturally depicts the relationships of the vascular architecture. This provides information about potential vascular inflows to be supplied, critical localizations of the tumor (affecting the vascular supply), and can thus also influence the choice of access route or other surgical steps [171]. While open surgical access and microscopic tumor removal via a Caldwell-Luc approach or (modified) midfacial degloving were more common a few years ago, the endonasal, endoscopic approach is preferred nowadays.…”

“…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. Dies gibt Auskunft über potentiell zu versorgende Gefäßzuflüsse, kritische Lokalisationen des Tumors (die Gefäßversorgung betreffend) und kann damit auch Einfluss haben auf die Wahl des Zugangswegs oder andere operative Schritte [171]. Während vor einigen Jahren noch offene chirurgische Zugangswege und eine mikroskopische Tumorentfernung über einen Mundvorhofzugang oder ein (modifiziertes) Midfacial degloving eher üblich waren, bevorzugt man heutzutage eher den endonasalen, endoskopischen Zugangsweg.…”