Vakharia Kunal, Lim Jaims, Waqas Muhammad, Tso Michael K, Levy Elad I, Siddiqui Adnan H, Davies Jason
Department of Neurosurgery, Mayo Clinic, Rochester, USA.
Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.
Cureus. 2021 Jun 21;13(6):e15804. doi: 10.7759/cureus.15804. eCollection 2021 Jun.
Objective The current mainstay treatment for juvenile nasopharyngeal angiofibromas (JNAs) is surgical resection, but embolization of primary feeding arteries through endovascular transarterial and direct tumoral puncture embolizations with various agents has been described. We describe a single institutional experience with JNA embolization utilizing Onyx (Medtronic, Dublin, Ireland). Methods A retrospective records review was performed to identify patients who underwent embolization for devascularization of Fisch grades II-IVa JNA (tumor extension beyond the sphenopalatine region) before surgical resection between 2010 and 2019. Fluoroscopy time, grade, intraoperative blood loss, and clinical follow-up data were compiled. Tumor devascularization percentage was calculated using ImageJ software (public domain, BSD-2) by measuring the ratio of preoperative and postoperative embolization tracing. Results Five consecutive patients (ages 12-16 years [average 14 years]; all male) with JNAs underwent preoperative transarterial embolizations performed under general anesthesia. All patients presented with epistaxis; two also presented with headaches. Fisch grades were II in two patients, IIIa in two, and IVa in one. The patient with the grade IVa lesion underwent direct transtumoral puncture and Onyx embolization. The mean percentage of all tumor devascularizations postembolization was 86.0±9.7%.Complete resection 24-48 hours postembolization was obtained for grades II and IIIa lesions with <700 mL blood loss. No embolization-related complications and no clinical sequelae were present in the five cases after embolization. Conclusion In our experience, Onyx embolization of JNAs was safely conducted with adequate tumor penetration beyond the sphenopalatine region through transarterial routes.
目的 目前青少年鼻咽血管纤维瘤（JNAs）的主要治疗方法是手术切除，但也有通过血管内经动脉以及使用各种药物进行直接肿瘤穿刺栓塞对主要供血动脉进行栓塞的报道。我们描述了在单一机构使用Onyx（美敦力公司，爱尔兰都柏林）栓塞治疗JNAs的经验。方法 进行回顾性病历审查，以确定2010年至2019年间在手术切除前因Fisch II-IVa级JNAs（肿瘤扩展至蝶腭区域以外）而接受血管栓塞治疗的患者。收集透视时间、分级、术中失血量和临床随访数据。使用ImageJ软件（公共领域，BSD-2）通过测量术前和术后栓塞造影的比例来计算肿瘤去血管化百分比。结果 5例连续的JNAs患者（年龄12-16岁[平均14岁]；均为男性）在全身麻醉下接受了术前经动脉栓塞治疗。所有患者均有鼻出血症状；2例还伴有头痛。Fisch分级为II级的患者2例，IIIa级2例，IVa级1例。IVa级病变患者接受了直接经肿瘤穿刺并使用Onyx栓塞。栓塞后所有肿瘤去血管化的平均百分比为86.0±9.7%。II级和IIIa级病变在栓塞后24-48小时实现了完全切除，失血量<700 mL。5例患者栓塞后均未出现栓塞相关并发症及临床后遗症。结论 根据我们的经验，通过经动脉途径对JNAs进行Onyx栓塞可安全实施，肿瘤穿透蝶腭区域以外的情况良好。
