title: Preoperative Embolization to Improve the Surgical Management and Outcome of Juvenile Nasopharyngeal Angiofibroma (JNA) in a Single Center: 10-Year Experience.
abstract: OBJECTIVE
  Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent male individuals.
  
  
  METHODS
  We performed a retrospective study to determine the efficacy and safety of preoperative embolization and the surgical outcome in patients with JNA in a single-center institution. Fifteen cases undergoing embolization and surgical treatment between April 2003 and February 2013 were evaluated retrospectively. The demographic data, clinical presentation, and treatment were reviewed including the kind of preoperative embolization and different surgical approaches performed. The parameters investigated were the amount of blood loss, the tumor stage, and the rates of recurrence. Subsequently, a comparison was made between patients who had undergone Onyx®embolization versus those who had been embolized with the standard approach.
  
  
  RESULTS
  In these 15 patients (mean age, 15 years), a total of 27 surgical procedures were performed. One patient was at stage Ia, two were at stage Ib, two were at stage IIa, six were at stage IIb, one was at stage IIc, and three were at stage IIIa based on the Radkowsky classification. All patients underwent preoperative embolization and subsequent surgery. The surgical approach and the embolization technique varied and evolved during time. The embolization procedure decreased the intraoperative blood loss to a minimum of 250 ml, and with the advent of intratumoral embolization, the rate of recurrence diminished.
  
  
  CONCLUSIONS
  Preoperative Onyx®embolization facilitates the shift in the treatment to endoscopic excision in selected patients, which reduces recurrence rates and overall morbidity.
authors: Department of Neuroradiology, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany. Juergen.Lutz@med.uni-muenchen.de.
authors: J
authors: J
authors: Lutz
authors: Department of Neuroradiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors: M
authors: M
authors: Holtmannspötter
authors: Department of Radiology, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors: W
authors: W
authors: Flatz
authors: Department of Anesthesia, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors: A
authors: A
authors: Meier-Bender
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors: A
authors: A
authors: Berghaus
authors: Department of Neuroradiology, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors: H
authors: H
authors: Brückmann
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors: P
authors: P
authors: Zengel
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000473:pathology* / Q000628:therapy*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D010611:Pharyngectomy / Q000379:methods; D011145:Polyvinyls / Q000627:therapeutic use; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Blood loss; Direct puncture; Juvenile nasopharyngeal angiofibroma; Preoperative embolization
references: J Neurosurg. 2010 May;112(5):1039-45
references: 19698039
references: Acta Neurochir (Wien). 2002 Nov;144(11):1157-64
references: 12434172
references: AJNR Am J Neuroradiol. 2010 May;31(5):961-6
references: 20037136
references: AJNR Am J Neuroradiol. 2006 Oct;27(9):1907-9
references: 17032863
references: Head Neck. 1997 Aug;19(5):391-9
references: 9243266
references: Laryngoscope. 1989 Apr;99(4):429-37
references: 2538688
references: Arch Otolaryngol Head Neck Surg. 2002 Aug;128(8):928-35
references: 12162773
references: Neurosurgery. 2008 Jun;62(6):1204-11; discussion 1211-2
references: 18824987
references: Acta Otolaryngol. 2009 Dec;129(12):1456-62
references: 19922097
references: J Neurosurg. 2009 Jan;110(1):124-7
references: 18847339
references: J Craniomaxillofac Surg. 2006 Jan;34(1):3-8
references: 16343920
references: Head Neck Surg. 1979 Nov-Dec;2(2):119-28
references: 233745
references: Australas Radiol. 2007 Oct;51(5):446-52
references: 17803797
references: Int J Pediatr Otorhinolaryngol. 2009 Mar;73(3):401-8
references: 19124161
references: J Laryngol Otol. 1996 Oct;110(10 ):962-8
references: 8977863
references: Cardiovasc Intervent Radiol. 1995 May-Jun;18(3):158-61
references: 7648591
references: Arch Otolaryngol Head Neck Surg. 1996 Feb;122(2):122-9
references: 8630204
references: AJNR Am J Neuroradiol. 1993 May-Jun;14(3):571-82
references: 8517342
references: Acta Otolaryngol. 1988 Jan-Feb;105(1-2):132-9
references: 2829500
references: Otolaryngol Head Neck Surg. 2008 May;138(5):581-6
references: 18439462
references: Neuroradiology. 1978;16:418-9
references: 218139
references: Ann Otol Rhinol Laryngol. 1984 Jul-Aug;93(4 Pt 1):322-9
references: 6087710
references: Radiology. 2001 Nov;221(2):309-17
references: 11687669
references: Int J Pediatr Otorhinolaryngol. 2008 Jun;72(6):793-800
references: 18387676
references: Laryngoscope. 1987 Nov;97(11):1319-25
references: 2823033
references: AJNR Am J Neuroradiol. 1999 Aug;20(7):1323-8
references: 10472993