Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary?,CardioVascular and Interventional Radiology

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Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary?
CardioVascular and Interventional Radiology ( IF 2.8 ) Pub Date : 2023-07-10 , DOI: 10.1007/s00270-023-03483-1
Qiang Liu ₁ , Zhipeng Xia ₁ , Rujian Hong ₁ , Yucheng Pan ₁ , Kai Xue ₂ , Quan Liu ₂ , Xicai Sun ₂ , Houyong Li ₂ , Yan Sha ₁ , Hongmeng Yu ₂ , Dehui Wang ₂

Affiliation

Purpose

To determine the effects of blood supply from internal carotid artery (ICA) on the surgical outcomes of primary juvenile nasopharyngeal angiofibroma (JNA) after transarterial embolization (TAE).

Methods

A retrospective analysis was performed on primary JNA patients who underwent TAE and endoscopic resection in our hospital between December 2020 and June 2022. The angiography images of these patients were reviewed, and then they were divided into ICA + external carotid artery (ECA) feeding group and ECA feeding group according to whether the ICA branches were part of the feeding arteries. Tumors in ICA + ECA feeding group were fed by both ICA and ECA branches, while tumors in ECA feeding group were fed by ECA branches alone. All patients underwent tumor resection immediately after ECA feeding branches embolization. None of the patients underwent ICA feeding branches embolization. Data on demographics, tumor characteristics, blood loss, adverse events, residual and recurrence were collected, and case–control analysis was performed for the two groups. Differences in characteristics between the groups were tested using Fisher’s exact and Wilcoxon tests.

Results

Eighteen patients were included in this study: nine in ICA + ECA feeding group and nine in ECA feeding group. The median blood loss was 700 mL (IQR 550–1000 mL) in ICA + ECA feeding group versus 300 mL (IQR 200–1000 mL) in ECA feeding group, with no significant statistical difference (P = 0.306). Residual tumor was found in one patient (11.1%) in both groups. Recurrence was not observed in any patient. There were no adverse events from embolization and resection in either group.

Conclusion

The results of this small series suggest that the presence of blood supply from ICA branches in primary JNA has no significant effect on intraoperative blood loss, adverse event, residual and postoperative recurrence. Therefore, we do not recommend routine preoperative embolization of ICA branches.

Level of Evidence

Level 4, Case–control.

Graphical Abstract

中文翻译：

原发性青少年鼻咽血管纤维瘤的术前栓塞：颈内动脉分支栓塞有必要吗？

目的

目的确定颈内动脉 (ICA) 供血对原发性青少年鼻咽血管纤维瘤 (JNA) 经动脉栓塞 (TAE) 术后手术结果的影响。

方法

对2020年12月至2022年6月期间在我院接受TAE和内镜切除术的原发JNA患者进行回顾性分析，回顾这些患者的血管造影图像，然后将其分为ICA+颈外动脉（ECA）供血组根据 ICA 分支是否是喂养动脉的一部分，选择 ECA 喂养组。ICA+ECA喂养组的肿瘤由ICA和ECA分支同时喂养，而ECA喂养组的肿瘤仅由ECA分支喂养。所有患者在ECA供血分支栓塞后立即接受肿瘤切除术。所有患者均未接受 ICA 供血分支栓塞术。收集人口统计学、肿瘤特征、失血量、不良事件、残留和复发的数据，并对两组进行病例对照分析。使用 Fisher 精确检验和 Wilcoxon 检验测试了各组之间特征的差异。

结果

本研究纳入 18 名患者：ICA + ECA 喂养组 9 名患者，ECA 喂养组 9 名患者。ICA + ECA 喂养组的中位失血量为 700 mL（IQR 550–1000 mL），而 ECA 喂养组的中位失血量为 300 mL（IQR 200–1000 mL），无显着统计学差异（ P = 0.306 ）。两组均发现1例患者（11.1%）残留肿瘤。在任何患者中均未观察到复发。两组均未出现栓塞和切除不良事件。