Abstract
Object:
Juvenile nasopharyngeal angiofibroma (JNA) is the most common tumor of the nasopharynx. The main treatment modality for these tumors is surgery. Embolization has been shown to reduce surgical morbidity. Until recently, the conventional method of embolization of JNAs has been through a transarterial route. Although effective, transarterial embolization of vascular tumors has limitations. In this report, we describe a novel method of endoscopic-assisted direct percutaneous embolization of JNAs using Onyx.
Methods:
Two patients, 16 and 13 years old, with JNA underwent endoscopic-assisted direct percutaneous embolization of their tumors using Onyx. In each case, angiogram of the tumor was obtained through a transfemoral approach and the angioarchitecture of the tumor was delineated. A spinal needle was then inserted into the tumor under direct vision using a rigid endoscope. Under continuous fluoroscopy, Onyx 18 was injected directly into the tumor parenchyma.
Result:
In both cases, more than 90% of the tumor was embolized using Onyx. There were no complications related to the embolization. The procedures were performed in less than 1 hour (including anesthesia time). The tumors were resected endoscopically with minimal blood loss.
Conclusion:
Localization of JNAs with endoscopic assistance and insertion of the spinal needle under direct vision is a novel method that provides much better preoperative embolization than the classic transarterial route. Onyx can be an effective embolic agent that can be used for direct percutaneous embolization of vascular tumors such as JNAs.