Preoperative Embolization to Improve the Surgical Management and Outcome of Juvenile Nasopharyngeal Angiofibroma (JNA) in a Single Center: 10-Year Experience

• Published in: Clinical neuroradiology (Munich) 2016-12, Vol.26 (4), p.405-413
• Main Authors: Lutz, J., Holtmannspötter, M., Flatz, W., Meier-Bender, A., Berghaus, A., Brückmann, H., Zengel, P.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Angiofibroma - pathology; Angiofibroma - therapy; Blood Loss, Surgical - prevention & control; Child; Combined Modality Therapy - methods; Dimethyl Sulfoxide - therapeutic use; Embolization, Therapeutic - methods; Female; Hemostatics - therapeutic use; Humans; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - therapy; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Neurology; Neuroradiology; Neurosurgery; Original Article; Pharyngectomy - methods; Polyvinyls - therapeutic use; Preoperative Care - methods; Prognosis; Retrospective Studies; Treatment Outcome
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-015-0374-2

Purpose Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent male individuals. Methods We performed a retrospective study to determine the efficacy and safety of preoperative embolization and the surgical outcome in patients with JNA in a single-center institution. Fifteen cases undergoing embolization and surgical treatment between April 2003 and February 2013 were evaluated retrospectively. The demographic data, clinical presentation, and treatment were reviewed including the kind of preoperative embolization and different surgical approaches performed. The parameters investigated were the amount of blood loss, the tumor stage, and the rates of recurrence. Subsequently, a comparison was made between patients who had undergone Onyx ® embolization versus those who had been embolized with the standard approach. Results In these 15 patients (mean age, 15 years), a total of 27 surgical procedures were performed. One patient was at stage Ia, two were at stage Ib, two were at stage IIa, six were at stage IIb, one was at stage IIc, and three were at stage IIIa based on the Radkowsky classification. All patients underwent preoperative embolization and subsequent surgery. The surgical approach and the embolization technique varied and evolved during time. The embolization procedure decreased the intraoperative blood loss to a minimum of 250 ml, and with the advent of intratumoral embolization, the rate of recurrence diminished. Conclusion Preoperative Onyx ® embolization facilitates the shift in the treatment to endoscopic excision in selected patients, which reduces recurrence rates and overall morbidity.