title: Preoperative direct puncture embolization of advanced juvenile nasopharyngeal angiofibroma in combination with transarterial embolization: an analysis of 22 consecutive patients.
abstract: OBJECTIVE
  This study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE).
  
  
  METHODS
  The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20-25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE.
  
  
  RESULTS
  The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion.
  
  
  CONCLUSIONS
  The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.
authors.affiliation: Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, People's Republic of China. lvmingming001@163.com
authors.forename: Ming-Ming
authors.initials: MM
authors.lastname: Lv
authors.forename: Xin-Dong
authors.initials: XD
authors.lastname: Fan
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Su
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D018322:Angiofibroma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009305:Nasopharynx / Q000098:blood supply / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D061214:Patient Safety; D011300:Preoperative Care / Q000379:methods; D011677:Punctures / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome