Preoperative embolization of nasopharyngeal angiofibromas: The role of direct percutaneous injection of cyanoacrylate glue in conjunction with particulate endovascular approach

Abstract

Purpose: The aim of this study was to assess the clinical application, extent of tumour devascularization and surgical outcome after embolization of nasopharyngeal angiofibromas prior to surgery by using percutaneous cyanoacrylate glue and endovascular particulate material. We discuss our primary experience, and describe technical considerations and potential complications of the procedure. Subjects and methods: This study reports 29 patients with juvenile nasopharyngeal angiofibromas; that were embolized prior to surgical resection with percutaneous glue and endovascular particulate material; with surgery performed 24–72 h later. Preoperative and postoperative imaging studies were reviewed. Documented intraoperative blood loss was obtained and analysed. Results: Almost complete radiographic devascularization was encountered in 26 of 29 tumours. An average of 3.2 spinal needles was placed in the tumours. An average of 4.2 mL of cyanoacrylate glue was injected into each tumour. The estimated mean of the blood transfused during the operations was 150 mL. The embolization procedure proved to be safe and effective with no major or serious complications. Conclusion: The embolization of nasopharyngeal angiofibromas before surgery using percutaneous cyanoacrylate glue with endovascular particulate material proved to efficiently devascularize these tumours with lower blood loss during surgery and no major procedural complications.

Keywords

• Nasopharyngeal angiofibromas
• Direct percutaneous embolization
• Cyanoacrylate glue