Single-Center Experiences of Preoperative Juvenile Nasal Angiofibroma Embolization With Gelfoam, Reducing Financial Burden on Patients in Developing Country

Abstract

IntroductionJuvenile nasal angiofibroma (JNA) is a highly vascular tumor of the nasopharynx. Endovascular embolization followed by surgery is the treatment of choice. This study aimed to determine that single catheter technique with Gelfoam is an effective and safe technique for embolization to reduce the financial burden on patients in a developing country. Materials and methodsWe retrospectively reviewed the imaging, surgical, and histopathological records of 108 patients who underwent preoperative endovascular tumor embolization followed by surgical resection between March 2017 and March 2021. ResultsAfter embolization no major complication was observed in any patient. Complete devascularization of tumor was done in 87.8%. Intraoperative blood loss resulting in transfusion was almost the same as with other embolization techniques. ConclusionSingle catheter with Gelfoam is a cost-effective and safe technique for JNA embolization.

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

“…There is no clear data demonstrating a clinical benefit to a shorter preoperative time interval. Therefore, we speculate it is efficacious to perform surgery within 96 hours of embolization except in the case of using Gelfoam, which should occur within 48 hours of surgery to avoid the risk of recanalization 14 …”

“…Gelfoam is comparatively inexpensive and often utilized in low-resource settings. 14 Postembolization recanalization with Gelfoam can occur within 48 hours, potentially limiting its efficacy. 14 Cyanoacrylate and Onyx are both liquid polymers that result in permanent casting and thrombosis of vessels once the materials contact blood.…”

“…14 Postembolization recanalization with Gelfoam can occur within 48 hours, potentially limiting its efficacy. 14 Cyanoacrylate and Onyx are both liquid polymers that result in permanent casting and thrombosis of vessels once the materials contact blood. 32 Both materials have been shown to be safe and effective in reducing intraoperative blood loss and improving visualization during JNA resection, although no study included in this analysis utilized Onyx.…”

“…[9][10][11] Studies have described the use of several embolic materials, including polyvinyl alcohol (PVA) particles, embolic coils, Gelfoam (Pfizer), cyanoacrylate, and Onyx (Medtronic). 9,[12][13][14][15] To date, there are no definitive analyses that demonstrate the superiority of any single embolization technique, material, or timeframe prior to surgery. As a result, institutional protocols based on the experience of the treatment team tend to dominate decision-making.…”

“…Transarterial embolization (TAE), direct puncture embolization (DPE), and a combination of TAE and DPE are the most common techniques for preoperative embolization in JNA surgery 9‐11 . Studies have described the use of several embolic materials, including polyvinyl alcohol (PVA) particles, embolic coils, Gelfoam (Pfizer), cyanoacrylate, and Onyx (Medtronic) 9,12‐15 …”