Association of Preoperative Embolization and Vascularization Patterns With Outcomes in Juvenile Nasopharyngeal Angiofibroma Resection.

Abstract

Preoperative vascular embolization (PVE) is commonly used in managing juvenile nasopharyngeal angiofibroma (JNA) to improve outcomes. However, few studies have evaluated how embolization patterns and vascular features affect prognosis. A 15-year retrospective review was performed on 44 patients with JNA undergoing surgery at one institution. Data included demographics, vascular supply, embolization techniques, surgical outcomes, and recurrence. Forty-three patients underwent PVE. Most tumors were embolized transarterially (93.0%) using polyvinyl alcohol-based agents (79.1%). The internal maxillary artery was most commonly embolized (93.0%). Internal carotid artery supply was present in 34.9%, and more than two vessels were embolized in 23.3%. Postembolization tumor blush occurred in 60.5%, with a median of 5% of the pre-embolization blush remaining after embolization. Neither internal carotid involvement, number of vessels embolized, nor residual blush significantly impacted operative time, surgical outcomes, or recurrence. With effective embolization, vascular complexity might not affect JNA resection outcomes. Multicenter studies are required to confirm those findings.