Learning objectives
To review epidemiologic,
clinical,
anatomical and imaging features and patterns of vascularization of juvenile nasopharyngeal angiofibroma (JNA)
To outline the importance of preoperative embolization in the treatment of JNA
To be familiar with the technical aspects and the protocol of the embolization procedure
Background
EPIDEMIOLOGY
JNA is a vascular non-capsulated neoplasm, histologically benign but locally aggressive.
It represents 0,05% of all head and neck tumors and is the most common benign nasopharyngeal neoplasm,
tipically occurringin young males between 9 and 19 years of age [1].
ANATOMY
The exact site of origin of the lesion is controversial,
because thismass usually presents when it has reached considerable size.JNA is thought to originate in the pterygopalatine fossa in the area of the sphenopalatine foramen; some authors consider the site of origine at...
Findings and procedure details
Our technique of JNA embolization is mainly based on the systematic approach first described by Lasjaunias in 1980 [16].
Procedureto be planned 24-48 hours before surgery in order to minimize the risk of revascularization.
Right femoral arteryaccess under local anaesthesia; 4-FrenchVertebral catheter(Terumo,
Japan)inserted to obtain selective diagnosticangiograms ofcontrolateral internal and external carotid artery (lateral and anteroposterior projections),
followed by ipsilateral internal and external carotid artery.
Lateral projection is the most useful for ICA and proximal ECA,
while anteroposterior better profiles distal ECA branches (Fig. 4)....
Conclusion
Preoperative embolization of JNA is useful in reducing intraoperative blood loss and we recommend it as a routine preoperative step in all patientswith JNA.
A detailed analysis of the lesion and its vascular supply isnecessary for safe embolization procedure.
Personal information
Giulia Bonera,
MD; Department of Radiology,
Spedali Civili di Brescia,
Piazzale Spedali Civili 1 25123 Brescia (Italy).
Isabella Nicoli,
MD,University of Brescia,
Department of Radiology,
Spedali Civili di Brescia,
Piazzale Spedali Civili 1 25123 Brescia (Italy).
Raffaele Cuomo,
MD; Department of Radiology,
Spedali Civili di Brescia,
Piazzale Spedali Civili 1 25123 Brescia (Italy).
Marco Ravanelli,
MD; Department of Radiology,
Spedali Civili di Brescia,
Piazzale Spedali Civili 1 25123 Brescia (Italy).
Davide Farina,
MD; University of Brescia,
Department of Radiology,
Spedali Civili di Brescia,
Piazzale Spedali...
References
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Hodges J,
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El-Sayed AI,...
