title: Preliminary experience with the percutaneous embolization of juvenile angiofibromas using only ethylene-vinyl alcohol copolymer (Onyx) for preoperative devascularization prior to surgical resection.
abstract: OBJECTIVE
  Juvenile angiofibromas are hypervascular tumors that may benefit from preoperative devascularization to reduce intraoperative blood loss. Our purpose was to evaluate the extent of angiographic devascularization and intraoperative blood loss by using only Onyx for percutaneous juvenile angiofibroma tumor embolization.
  
  
  METHODS
  We reviewed the clinical records and preoperative and postoperative imaging studies of a consecutive series of 9 patients with juvenile angiofibromas who were treated with preoperative embolization with direct percutaneous injection of Onyx followed by resection from a standard open surgical or endoscopic approach.
  
  
  RESULTS
  Two Fisch type I, 1 Fisch type II, 5 Fisch type IIIa, and 1 Fisch type IVa tumor were treated. Complete devascularization was achieved in all cases percutaneously with only Onyx. There were no complications. The average intraoperative blood loss was 567.7 mL (range, 10-1700 mL). An average of 2.2 needles (range, 1-5 needles) was placed into the tumor. An average of 14.6 mL of Onyx (range, 2-25 mL) was injected into each tumor. Four Fisch type IIIa tumors were removed completely from only an ENE approach.
  
  
  CONCLUSIONS
  Presurgical direct percutaneous embolization of a juvenile angiofibroma with only EVOH before surgical resection is safe and feasible. Our preliminary experience suggests that Onyx may offer a higher degree of devascularization compared with other embolic agents. This may facilitate an easier surgical resection with lower blood loss.
authors.affiliation: Division of Interventional Neuroradiology, Department of Radiology, University of Michigan Health System, UH B1D 328, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030, USA. gemmete@med.umich.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Gemmete
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: A S
authors.initials: AS
authors.lastname: Pandey
authors.forename: S E
authors.initials: SE
authors.lastname: Sullivan
authors.forename: E L
authors.initials: EL
authors.lastname: McKean
authors.forename: L J
authors.initials: LJ
authors.lastname: Marentette
authors.forename: N
authors.initials: N
authors.lastname: Chaudhary
mesh_terms: D000293:Adolescent; D018322:Angiofibroma / Q000000981:diagnostic imaging* / Q000628:therapy*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011145:Polyvinyls / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide