Maroda Andrew J, Beckmann Nicholas A, Sheyn Anthony M, Elijovich Lucas, Michael L Madison, DiNitto Julie M, Rangarajan Sanjeet V
Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Int J Pediatr Otorhinolaryngol. 2020 Mar;130:109805. doi: 10.1016/j.ijporl.2019.109805. Epub 2019 Dec 4.
OBJECTIVES/PURPOSE: 1. Understand three different techniques for embolization of juvenile nasal angiofibroma (JNA) and assess their combined efficacy. 2. Perform successful endoscopic intralesional embolization of highly vascular sinonasal neoplasms.
In this study, we present the case of a 10-year-old male patient diagnosed with juvenile nasal angiofibroma (JNA) who successfully underwent trimodal embolization and resection at a tertiary academic medical center after failed coil embolization in his home country. We examine the clinical details of the case and a review of pertinent literature.
Preoperative embolization is common in the treatment of JNA, but there is little consensus as to the proper timeframe and techniques utilized. In our case, preoperative imaging revealed a vascular tumor with intracranial extension consistent with UPMC Stage V JNA. Diagnostic angiogram revealed significant arborization from the internal and external carotid systems. A trimodal embolization technique, utilizing transarterial, percutaneous, and direct endoscopic intralesional injection of n-Butyl Cyanoacrylate (n-BCA) was performed. A two-staged endoscopic and open resection was subsequently performed one week later with minimal blood loss. In our case, combining intralesional embolization with traditional transarterial techniques resulted in an improved operative field and a successful clinical result.
Embolization of highly vascular sinonasal tumors with n-BCA is not limited to endovascular techniques, but can be safely combined with percutaneous and endoscopic intralesional embolization up to one week prior to surgical resection.
在本研究中，我们报告了一名10岁男性患者的病例，该患者被诊断为青少年鼻血管纤维瘤（JNA），在其祖国进行弹簧圈栓塞失败后，于一家三级学术医学中心成功接受了三联栓塞和切除术。我们研究了该病例的临床细节并回顾了相关文献。
术前栓塞在JNA治疗中很常见，但对于合适的时间框架和使用的技术几乎没有共识。在我们的病例中，术前影像学显示一个伴有颅内扩展的血管性肿瘤，符合UPMC V期JNA。诊断性血管造影显示颈内和颈外动脉系统有明显的分支。采用了一种三联栓塞技术，即经动脉、经皮和直接内镜瘤内注射正丁基氰基丙烯酸酯（n-BCA）。一周后随后进行了两阶段的内镜和开放性切除，术中出血极少。在我们的病例中，将瘤内栓塞与传统经动脉技术相结合，改善了手术视野并取得了成功的临床结果。
用n-BCA栓塞高血运鼻窦肿瘤不限于血管内技术，而是可以在手术切除前一周安全地与经皮和内镜瘤内栓塞相结合。
