Embolization Decreases Blood Loss Resulting from Surgical Excisions of Juvenile Nasopharyngeal Angiofibroma

by Linda Kossoff •

CLINICAL QUESTION

What are the comparative outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non-embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE)?

BOTTOM LINE

Embolization decreased blood loss in JNA resection, and DPE led to improved recurrence and complication rates when compared to TAE.

BACKGROUND: Juvenile nasopharyngeal angiofibroma is a rare, benign, highly vascular tumor that commonly presents in young boys and adolescent males. These neoplasms typically expand with destructive growth and may have significant morbidity. Although surgical excision can cure JNAs, there is a risk of hemorrhage, which may be addressed through DPE or TAE.

STUDY DESIGN: Systematic review

SETTING: Pritzker School of Medicine, University of Chicago, Illinois

SYNOPSIS: Researchers mined multiple databases for publications investigating surgical resection of JNA with or without pre-operative embolization. A total of 61

studies representing 917 patients were included for review. Information on embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Within the cohort, 79.3% underwent pre-operative embolization. Of those embolized for whom the information was available (n = 691), 75.8% (n = 551) underwent TAE, 15.8% (n = 115) underwent DPE, and 3.6% (n = 25) underwent both embolization types. Analysis of available data showed that JNA recurrence in embolized patients was lower than in non-embolized patients (9.3% versus 14.4%), and that DPE resulted in lower rates of disease recurrence (0% versus. 9.5%) and complications (1.8% versus 21.9%) than TAE. Comparing 391 embolized patients and 99 non-embolized patients for whom there was intra-operative blood loss data, average blood loss was significantly lower in embolized patients (842 mL versus 1525 mL). The average blood loss during surgery was similar between DPE and TAE. Study limitations included inconsistency in available data and heterogeneity in surgical procedures.

CITATION: Diaz A, Wang E, Bujnowski D, et al. Embolization in juvenile nasopharyngeal angiofibroma surgery: a systematic review and meta-analysis. Laryngoscope. 2023;133:1529-1539.