Bilateral non-superselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note.
Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.
Department of Neurosurgery and Neurological Endovascular Therapy, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS), Universidad Nacional Autónoma de México (UNAM); Mexico City, Mexico.
J A
JA
Santos-Franco
A
A
Lee
L A
LA
Campos-Navarro
J
J
Tenorio-Sánchez
M
M
Zenteno
A R
AR
Osorio-Alvarado
D000293:Adolescent; D018322:Angiofibroma / Q000098:blood supply / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002343:Carotid Artery, Internal; D004621:Embolization, Therapeutic / Q000379:methods*; D004844:Epistaxis / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000098:blood supply / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome