SURGICAL OUTCOME OF PATIENTS UNDERGOING PREOPERATIVE EMBOLIZATION FOR NASOPHARYNGEAL ANGIOFIBROMA

Dinesh Chataut, Sundar Suwal, Ranjit Kumar Chaudhary, Prakash Kayastha, Sharma Paudel, Ram Kumar Ghimire, Bibhu Pradhan, Urmila Gurung, Kripa Dongol

Abstract


Background: Nasopharyngeal angiofibroma is highly vascular and aggressive tumor seen commonly seen in adolescent males. Per-operative bleeding is major concern for surgical treatment of the tumor. There are many methods of preoperative reduction of tumor vascularity, including trans-arterial embolization. This study was aimed to find out surgical outcome of nasopharyngeal angiofibroma following transarterial embolization.

Methods: Retrospective review of medical records of patients who underwent transarterial embolization prior to surgery for nasopharyngeal angiofibroma between April 2013 and August 2017 was done. Demographics, presenting complaints, tumor stage, arteries embolized, embolizing agent used and amount of blood loss were recorded.

Results: Twelve patients, all male mostly in adolescence underwent preoperative embolization with gelatin sponge particles. More than half of the cases were Fisch stage I with only case being stage IV. Unilateral internal maxillary was embolized in all cases except for in stage IV patient in whom besides bilateral internal maxillary artery, ascending pharyngeal artery was also embolized. Blood loss ranged from 100 ml to 1300 ml with maximum blood loss in stage IV patients. 

Conclusion: Preoperative transarterial embolization with particles are safe and efficient method of reducing intraoperative blood loss in patients undergoing surgery for nasopharyngeal angiofibroma.

Keywords: Nasopharyngeal Angiofibroma, Preoperative embolization, Outcome


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References


Garça MF, Yuca SA, Yuca K. Juvenile nasopharyngeal angiofibroma. Eur J Gen Med [Internet]. 2010;7(4):419–25. Available from: https://www.ejgm.co.uk/article/juvenile-nasopharyngeal-angiofibroma-6819

Reddy GRK, Rao PN. Nasopharyngeal Angiofibroma. A case series. J Evol Med Dent Sci. 2013;2(27):4994–5002.

Davis KR. Embolization of epistaxis and juvenile nasopharyngeal angiofibromas. Am J Roentgenol [Internet]. 1987;148(1):209–18. Available from: https://www.ajronline.org/doi/10.2214/ajr.148.1.209

Panda NK, Gupta G, Sharma S, Gupta A. Nasopharyngeal angiofibroma-changing trends in the management. Indian J Otolaryngol Head Neck Surg [Internet]. 2012;64(3):233–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431533/

Martins MBB, Lima FVF de, Mendonça CA, Jesus EPF de, Santos ACG, Barreto VMP, et al. Nasopharyngeal angiofibroma: Our experience and literature review. Int Arch Otorhinolaryngol [Internet]. 2013;17(1):14–9. Available from: https://pubmed.ncbi.nlm.nih.gov/25991988/

Huang Y, Liu Z, Wang J, Sun X, Yang L, Wang D. Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012. Laryngoscope [Internet]. 2014;124(8):1942–6. Available from: https://pubmed.ncbi.nlm.nih.gov/24222212/

Economou TS, Abemayor E, Ward PH. Juvenile nasopharyngeal angiofibroma: an update of the UCLA experience, 1960–1985. Laryngoscope [Internet]. 1988;98(2):170–5. Available from: https://pubmed.ncbi.nlm.nih.gov/3339927/

Ballah D, Rabinowitz D, Vossough A, Rickert S, Dunham B, Kazahaya K, et al. Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre. Clin Radiol [Internet]. 2013;68(11):1097–106. Available from: https://pubmed.ncbi.nlm.nih.gov/23911010/

Gao M, Gemmete JJ, Chaudhary N, Pandey AS, Sullivan SE, McKean EL, et al. A comparison of particulate and onyx embolization in preoperative devascularization of juvenile nasopharyngeal angiofibromas. Neuroradiology [Internet]. 2013;55(9):1089–96. Available from: https://pubmed.ncbi.nlm.nih.gov/23748913/

Kasem MAHO, Awad AS, Al Bosraty HADM, Kamel AI. Preoperative embolization of nasopharyngeal angiofibromas: The role of direct percutaneous injection of cyanoacrylate glue in conjunction with particulate endovascular approach. Egypt J Radiol Nucl Med [Internet]. 2016;47(4):1431–41. Available from: https://www.sciencedirect.com/science/article/pii/S0378603X16301644

Ungkanont K, Byers RM, Weber RS, Callender DL, Wolf PF, Goepfert H. Juvenile nasopharyngeal angiofibroma: an update of therapeutic management. Head Neck J Sci Spec Head Neck [Internet]. 1996;18(1):60–6. Available from: https://www.ejgm.co.uk/article/juvenile-nasopharyngeal-angiofibroma-6819

Siniluoto TMJ, Luotonen JP, Tikkakoski TA, Leinonen ASS, Jokinen KE. Value of pre-operative embolization in surgery for nasopharyngeal angiofibroma. J Laryngol Otol [Internet]. 1993;107(6):514–21. Available from: https://pubmed.ncbi.nlm.nih.gov/8393907/

Tan G, Ma Z, Long W, Liu L, Zhang B, Chen W, et al. Efficacy of preoperative transcatheter arterial embolization for nasopharyngeal angiofibroma: A comparative study. Cardiovasc Intervent Radiol [Internet]. 2017;40(6):836–44. Available from: https://pubmed.ncbi.nlm.nih.gov/28175976/

Punj J, Chopra S, Garg A, Pandey R, Darlong V, Sinha R. Perioperative Management of Juvenile Nasopharyngeal Angiofibroma: A Retrospective Analysis of 56 Patients From a Single Tertiary Care Institute. AANA J [Internet]. 2016;84(5). Available from: https://pubmed.ncbi.nlm.nih.gov/31554567/

Önerci M, Gumus K, Cil B, Eldem B. A rare complication of embolization in juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol [Internet]. 2005;69(3):423–8. Available from: https://pubmed.ncbi.nlm.nih.gov/15733605/

Janakiram N, Sharma SB, Panicker VB, Srinivas C V. A drastic aftermath of Embolisation in Juvenile Nasopharyngeal Angiofibroma. Indian J Otolaryngol Head Neck Surg [Internet]. 2016;68(4):540–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083651/

Lasjaunias P. Nasopharyngeal angiofibromas: hazards of embolization. Radiology [Internet]. 1980;136(1):119–23. Available from: https://pubs.rsna.org/doi/10.1148/radiology.136.1.6247740

Vazquez A, Shukla PA, Choudhry OJ, Gandhi CD, Liu JK, Eloy JA. Geometric alopecia after preoperative angioembolization of juvenile nasopharyngeal angiofibroma. Allergy Rhinol [Internet]. 2013;4(1):ar-2013. Available from: https://journals.sagepub.com/doi/full/10.2500/ar.2013.4.0048


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