Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Department of Neuroradiology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Laryngoscope. 2021 Mar;131(3):E775-E780. doi: 10.1002/lary.29119. Epub 2020 Oct 1.
Preoperative embolization of juvenile nasopharyngeal angiofibroma (JNA) is usually performed by the occlusion of branches of the external carotid artery (ECA). However, a significant proportion of JNAs also receive blood from the internal carotid artery (ICA). The objective of this study was to report on the feasibility and clinical impact of superselective embolization of ICA branches in complex cases of JNA.
This was a single-center retrospective study of all patients operated on for JNA between 2000 and 2018. The patients treated with embolization of branches of the ICA were identified. The results in terms of complications, intraoperative blood loss, and rate of residual disease were analyzed and compared to those of a control group of patients treated only with embolization of ECA branches and matched by age, stage, angiographic pattern, surgical approach, and previous surgery.
Ninety-two patients were included. Embolization of branches of the ICA was attempted in 14 cases of advanced or recurrent tumors and was ultimately possible in nine cases. There were no complications after embolization. The mean intraoperative blood loss was 1428 mL. Residual disease was found in three cases (33%). There was no significant difference compared with the control group (mean intraoperative blood loss = 1355 mL, residual disease = 4 (44%); all P > .05).
In this retrospective study, we report the feasibility of superselective embolization of ICA branches in selected cases of JNA. There was no observed benefit of this technique in terms of intraoperative bleeding or decreased risk of residual disease.
4 Laryngoscope, 131:E775-E780, 2021.
青少年鼻咽血管纤维瘤（JNA）的术前栓塞通常通过颈外动脉（ECA）分支的闭塞来完成。然而，相当一部分 JNA 也从颈内动脉（ICA）获得血液供应。本研究旨在报告在复杂 JNA 病例中，超选择性栓塞 ICA 分支的可行性和临床影响。
这是一项对 2000 年至 2018 年间所有接受 JNA 手术治疗的患者进行的单中心回顾性研究。确定了接受 ICA 分支栓塞治疗的患者。分析并比较了这些患者的并发症、术中出血量和残留疾病率，与仅接受 ECA 分支栓塞治疗且年龄、分期、血管造影模式、手术入路和既往手术相匹配的对照组患者的结果。
共纳入 92 例患者。在 14 例晚期或复发性肿瘤患者中尝试了 ICA 分支栓塞，最终有 9 例成功进行了栓塞。栓塞后无并发症。术中平均失血量为 1428 毫升。3 例（33%）发现残留疾病。与对照组相比无显著差异（术中平均失血量=1355 毫升，残留疾病=4（44%）；均 P>.05）。
在这项回顾性研究中，我们报告了在选定的 JNA 病例中，超选择性栓塞 ICA 分支的可行性。就术中出血或降低残留疾病风险而言，该技术没有明显的优势。
4 级喉镜，131：E775-E780，2021 年。
