Trimodal Embolization of Juvenile Nasopharyngeal Angiofibroma with Intracranial Extension

Trimodal Embolization of Juvenile Nasopharyngeal Angiofibroma with Intracranial Extension:



Publication date: Available online 4 December 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Andrew J. Maroda, Nic A. Beckmann, Anthony Sheyn, Lucas Elijovich, Lattimore M. Michael, Julie DiNitto, Sanjeet Rangarajan

Abstract

Objectives/Purpose

1. Understand three different techniques for embolization of juvenile nasal angiofibroma (JNA) and assess their combined efficacy. 2. Perform successful endoscopic intralesional embolization of highly vascular sinonasal neoplasms.

Methods

In this study, we present the case of a 10-year-old male patient diagnosed with juvenile nasal angiofibroma (JNA) who successfully underwent trimodal embolization and resection at a tertiary academic medical center after failed coil embolization in his home country. We examine the clinical details of the case and a review of pertinent literature.

Results

Preoperative embolization is common in the treatment of JNA, but there is little consensus as to the proper timeframe and techniques utilized. In our case, preoperative imaging revealed a vascular tumor with intracranial extension consistent with UPMC Stage V JNA. Diagnostic angiogram revealed significant arborization from the internal and external carotid systems. A trimodal embolization technique, utilizing transarterial, percutaneous, and direct endoscopic intralesional injection of n-Butyl Cyanoacrylate (n-BCA) was performed. A two-staged endoscopic and open resection was subsequently performed one week later with minimal blood loss. In our case, combining intralesional embolization with traditional transarterial techniques resulted in an improved operative field and a successful clinical result.

Conclusion

Embolization of highly vascular sinonasal tumors with n-BCA is not limited to endovascular techniques, but can be safely combined with percutaneous and endoscopic intralesional embolization up to one week prior to surgical resection.