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Keywords:
Ear / Nose / Throat, Interventional vascular, Head and neck, Catheter arteriography, Embolisation, Neoplasia
Authors:
T. Amer, A. Elmokadem, A. M. AbdEl-khalek; Mansoura/EG
DOI:
10.1594/ecr2016/C-0329
Methods and materials
This study is a retrospective one,
where analysis of the clinical data of 20 adolescent males with radiologically documented and histologically proven juvenile angiofibroma was performed.
Their ages ranged from 6 to 20 years with a mean age of 14.6 years. All patients were treated surgically in the period from January 1997 to March,
2015.
Angiography and embolization procedures were carried out in the angiography and interventional unit.
Radiology Department,
Mansoura University Hospital,
Mansoura,
Egypt.
A written consent was obtained from one of the parents before angiography and embolization after clarification of the possible hazards of the technique.
All patients were subjected to surgical intervention in the ENT Department of the same hospital.
Pre and post contrast CT scan,
pre and post contrast MRI including the skull base region,
nasopharynx,
paranasal sinuses,
orbits and brain were performed in all patients before angiography and embolization for proper assessment of tumor extension.
All patients were categorized as stage (IV) according to Fisch Classification (11).
Technique of angiography and embolization;
A transfemoral route of catheterization was used & local anesthesia was sufficient in all patients.
Twenty-three embolization procedures were performed in 20 patients (three repeated embolization procedures were performed patients with recurrences).
Selective catheterizations were performed using 4 to 5 French catheters and micocatheters.
Before embolization in all patients a detailed diagnostic angiography including bilateral internal carotid and vertebral angiograms was performed,
then selective catheterization of the supplying artery of the tumor (the internal maxillary artery) as distal as possible,
either unilateral or bilateral was performed.
Then embolization was carried out using gelatin sponge slurry in 7 procedures (Gelfoam,
Ugohn company,
Kalamzoa,
Michigan,
USA),
Contour particles (Boston Scientific,
USA) in 12 procedures and Ivalon (PVA) in 4 procedures.
We used the small size particles of the Contour and Ivalon (45-150,
150-250 & 250-355 microns).
The internal maxillary artery (IMA) was embolized bilaterally in 4 patients and unilaterally in 16 patients.
After completion of embolization,
a post embolization supplying IMA or ECA angiogram was obtained.
Technique of Surgery;
Surgery was performed within 24-72 hours after the embolization procedure.
Two surgical approaches were used,
anterior subcranial,
transfacial and transmaxillary approach in 17 (85 %) patients,
and cranio-facial approach in three patients (15 %).
The surgeons were asked to calculate the amount of blood loss and the amount of blood transfusion during the operation.
They estimated the blood loss amount by measuring the fluid from the operative bed collected by suction and subtracting the amount of saline administrated during the surgery.