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Abstract - Technical Note

J Cerebrovasc Endovasc Neurosurg. 2020 22(2): 97-105
The Journal of Cerebrovascular and Endovascular Neurosurgery
A safer endovascular technique for pre-operative embolization of juvenile nasopharyngeal angiofibroma: avoiding the pitfalls of external carotid artery – internal carotid artery anastomoses
David Rosenbaum-Halevi1, Victor Lopez-Rivera1, Ali Turkmani2, Aditya Sanzgiri3, Hussein A. Zeineddine4, Amber Luong5, Peng Roc Chen4
1Department of Neurology, University of Texas Medical School at Houston, Houston, TX, USA, 2Department of Neurosurgery, Mayo Clinic, Pheonix, AZ, USA, 3Deptartment of Clinical Research, University of Chicago, Chicago, IL, USA, 4Department of Neurosurgery, University of Texas Medical School at Houston, Houston, TX, USA, 5Department of Otorhinolaryngology, University of Texas Medical School at Houston, Houston, TX, USA

Intra-arterial embolization of juvenile nasopharyngeal angiofibroma (JNA) prior to surgical resection is the preferred approach to minimize blood loss during surgical resection of the tumor. However, the presence of external carotid artery–internal carotid artery (ECA-ICA) anastomoses may hinder complete tumor embolization due to the associated risk for embolic complications. Here, we evaluate the use of a balloon-assisted embolization (BAE) technique in the treatment of JNA. We conducted a retrospective review of JNA patients who underwent tumor embolization with injection of Onyx in a single session between 2013-2018. All cases displayed tumor arterial supply from ECA and ICA circulations on 2-D catheter angiograms. Procedural and surgical outcome data were analyzed. Results are given as meanstandard deviation (range). Among 9 patients with JNA, all were males and mean age was 14.16.3 years (range, 9-29 years). The mean tumor volume embolization was 84.412.4% (range, 60-100%) and in 89% patients 80% of tumor volume embolization was achieved. There were no embolization-related complications reported. During surgical resection of the tumor there was a low average surgical blood loss of 722651.5 mL (range, 50-2,000 mL) and the mean procedure time was 282.685.4 mins (range, 151-403 mins). In this series, the BAE technique showed to be a safe and effective approach to achieve successful tumor embolization while avoiding embolic complications and effectively reducing the risk for blood loss during surgical resection.
Key words : Juvenile nasal angiofibroma, Embolization, Surgical resection, Anastomosis, Balloon-assisted, Technique

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