Department of Neurological Surgery, University of Miami MILLER School of Medicine, Miami, Florida, USA.
World Neurosurg. 2011 Sep-Oct;76(3-4):328-34; discussion 263-5. doi: 10.1016/j.wneu.2010.11.011.
Preoperative embolization of juvenile nasopharyngeal angiofibromas (JNA) has been shown to reduce operative times and blood loss. Although traditional transarterial (TA) embolization is commonly used, direct tumoral puncture (DTP) has also been advocated as an alternative. We report our series of JNAs embolized with Onyx and compare the two embolization techniques.
We retrospectively reviewed all JNAs embolized with Onyx at our institution during a 20-month period. The fluoroscopy time, percent of tumor devascularization, periprocedural complications, and intraoperative blood loss were compared between the two groups.
A total of 10 patients with JNA underwent preoperative embolization by a TA route (n = 5) or DTP (n = 5). Mean fluoroscopy time was 50 and 39 minutes in the TA and DTP groups, respectively. The mean percent tumor devascularization in the TA group was 77% compared with 93% in the DTP group. Intraoperative estimated blood loss in tumors embolized transarterially was higher than those embolized by DTP (862 mL vs. 412 mL); however, this difference did not reach statistical significance. There were no neurological complications related to the embolization procedures in either group.
Embolization of JNAs with Onyx can be performed safely by either method. Direct puncture is associated with shorter embolization procedure times and results in a greater degree of tumor devascularization. Although there was a trend toward lesser blood loss in patients embolized by DTP, it did not reach statistical significance in this small series. Larger series are needed to determine whether the improved tumor penetration achieved with DTP translates into clinical benefit.
术前对青少年鼻咽血管纤维瘤（JNA）进行栓塞已被证明可减少手术时间和出血量。虽然传统的经动脉（TA）栓塞术已广泛应用，但直接肿瘤穿刺（DTP）也被认为是一种替代方法。我们报告了使用 Onyx 栓塞 JNA 的系列病例，并比较了两种栓塞技术。
我们回顾性分析了我院在 20 个月期间用 Onyx 栓塞的所有 JNA。比较两组的透视时间、肿瘤血供阻断百分比、围手术期并发症和术中出血量。
共 10 例 JNA 患者接受术前栓塞治疗，采用 TA 途径（n = 5）或 DTP（n = 5）。TA 组和 DTP 组的平均透视时间分别为 50 分钟和 39 分钟。TA 组肿瘤血供阻断的平均百分比为 77%，而 DTP 组为 93%。经 TA 栓塞的肿瘤术中估计出血量高于经 DTP 栓塞的肿瘤（862 毫升比 412 毫升）；然而，这种差异没有达到统计学意义。两组均无与栓塞过程相关的神经并发症。
用 Onyx 栓塞 JNA 可以安全地通过任何一种方法进行。直接穿刺与较短的栓塞程序时间相关，并导致更大程度的肿瘤血供阻断。尽管 DTP 栓塞患者的出血量有减少的趋势，但在本小系列中未达到统计学意义。需要更大的系列来确定 DTP 实现的肿瘤穿透改善是否转化为临床益处。
