title: Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre.
abstract: OBJECTIVE
  To evaluate the relationship between intraoperative blood loss and juvenile nasopharyngeal angiofibroma (JNA) vascular supply and tumour stage in patients who underwent superselective external carotid artery (ECA) embolization. This series is unique in that all embolizations were performed by dedicated paediatric interventional radiologists at a tertiary referral paediatric centre.
  
  
  METHODS
  Seventeen male patients treated from January 2002 to August 2009 underwent preoperative angiography and embolization using polyvinyl alcohol (PVA) particles. Tumours were graded using three different staging systems based on preoperative imaging and correlated to surgical blood loss. All patients underwent bilateral internal and external carotid angiography, with embolization of ECA tumour supply via microcatheter delivery of PVA particles. Particle size ranged from 150-500 μm with a mean size of 250-355 μm. Surgical resection was performed with either endoscopic or open techniques within 24 h and intraoperative blood loss was reported.
  
  
  RESULTS
  Seven lesions were supplied strictly by the ECA circulation and had mean surgical blood loss of 336 ml. Twelve lesions had both ECA and internal carotid artery (ICA) supply and had mean surgical blood loss of 842 ml. The difference in blood loss in these two groups was statistically significant (p = 0.03). There was no case of inadvertent intracranial or ophthalmic embolization. There were statistically significant correlations between estimated surgical blood loss and the Andrews (p = 0.008), Radkowski (p = 0.015), and University of Pittsburgh Medical Center (UPMC; p = 0.015) preoperative tumour staging systems, respectively.
  
  
  CONCLUSIONS
  Preoperative embolization of JNA tumours can be safely performed without neurological complications. The present study identified a statistically significant difference in intraoperative blood loss between those lesions with a purely ECA vascular supply and a combination of ECA and ICA vascular supply. Angiography is helpful in delineating ICA supply and can help guide surgical planning.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: ballahd@email.chop.edu.
authors.forename: D
authors.initials: D
authors.lastname: Ballah
authors.forename: D
authors.initials: D
authors.lastname: Rabinowitz
authors.forename: A
authors.initials: A
authors.lastname: Vossough
authors.forename: S
authors.initials: S
authors.lastname: Rickert
authors.forename: B
authors.initials: B
authors.lastname: Dunham
authors.forename: K
authors.initials: K
authors.lastname: Kazahaya
authors.forename: A M
authors.initials: AM
authors.lastname: Cahill
mesh_terms: D000293:Adolescent; D018322:Angiofibroma / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002342:Carotid Artery, External / Q000000981:diagnostic imaging*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011142:Polyvinyl Alcohol; D011300:Preoperative Care / Q000379:methods; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D011142:Polyvinyl Alcohol