Application of Digital Subtraction Angiography in Predicting the Outcomes of Intraoperative Hemorrhage of Juvenile Nasopharyngeal Angiofibroma

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a very rare hemorrhagic vascular tumor that predominantly affects adolescent boys. The tumor is relatively large when detected, and the risk of intraoperative bleeding is high. We aimed to examine factors associated with intraoperative blood loss in JNA surgery. Thirteen patients with JNA who underwent surgery at the Jikei University Hospital between 2009 and 2020 were retrospectively reviewed, and factors associated with blood loss were examined by single regression analysis. The mean age was 20.8±7.7years. Preoperative angiographic images were evaluated in 9 of the 13 cases. The 6 patients with the largest bleeding volumes, all had residual nutrient vessels from the internal carotid artery (ICA), with an average number of 2.5 vessels. The mean blood loss of patients with residual nutrient vessels from the ICA was 3037±2568mL. Single regression analysis of bleeding volume against the number of remaining nutrient vessels from the ICA and the total peak contrast density of nutrient vessels (Cmax) standardized by region of interest showed that the coefficient was positive (P<0.05 for both), confirming a significant correlation between the 2, respectively. The amount of bleeding significantly correlated with the number of remaining nutrient vessels from the ICA after preoperative embolization and with the total Cmax/region of interest. The ability to predict the amount of preoperative blood loss using this study will facilitate proposals for external incisions in patients with JNA.