Juvenile angiofibroma: the role of diagnostic angiography and preoperative embolization in treatment
Journal Title: Postępy Nauk Medycznych - Year 2012, Vol 25, Issue 5
Abstract
<b>Introduction.</b> Juvenile nasopharyngeal angiofibroma (JNA) is a vascular nasopharyngeal tumor, which may lead to abundant nasal bleeding or profound intraoperative haemorrhage. For many surgeons superselective embolization of feeding vessels followed by surgery is an important part of patient management. The aim of the study is evaluation of preoperative angiography and embolization in patients with juvenile nasopharyngeal angiofibroma, as well as comparison of clinical and radiological findings.<br><b>Material and methods. </b>There were 25 patients aged 12-22 years. All patients underwent computed tomography and carotid arteriography. In 21 cases magnetic resonance imaging, and in 24 cases carotid embolization were performed. All tumors were staged according to Andrews classification system. All patients were treated surgically and the diagnosis was histopatologically comfirmed.<br><b>Results. </b>Classification results showed that 11 of the 25 tumors were stage II, 4 were stage IIIB, with stages I and IIIa including 5 tumors each. In all patients angiography showed findings typical for JNA. All tumors had blood supply from internal maxillary artery. The source of additional supply were: the ascending pharyngeal artery in 8 cases, the facial artery in 1 case, the internal carotid artery in 5 cases and the contralateral internal maxillary artery in 4 cases. Embolization was succesful in all patients except for the patient after external artery ligation. In 1 casetransient neurological deficit developed. Intraoperative bleeding in the embolized group was much smaller than in the non-embolized patient.<br><b>Conclusions. </b>Angiography establishes the diagnosis of JNA and enables embolization of its vasculature. Preoperative embolization is a safe procedure, which markedly reduces intraoperative bleeding.
Authors and Affiliations
Anna Szymańska, Tomasz Jargiełło, Marcin Szymański, Małgorzata Szczerbo-Trojanowska
Keywords
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