Cases Of Nasopharyngeal Angiofibroma Research Articles

Case Series of Pre-Operative Endovascular Embolization of Nasopharyngeal Angiofibroma Using Polyvinyl Alcohol Foam Particle: A Single Centre Experience

BACKGROUND:Nasopharyngeal Angiofibroma is a rare neoplasm in the sphenopalatine foramen. This tumour is histologically benign, but clinically malignant because it can erode the bone and surrounding structures, such as the pterygopalatine fossa, paranasal sinuses, and nasal cavity. It is a highly vascular tumour, sometimes from multiple Feeding arteries, and tends to bleed easily.CASE PRESENTATION:In these cases, series, we reported four cases of nasopharyngeal angiofibroma in children and one case in an elderly patient. The diagnosis was made by history taking, physical examination and Cerebral MSCT Angiography, as well as Digital Subtraction Angiography (DSA). After identification of the Feeding artery, we performed transarterial embolisation using polyvinyl alcohol (PVA) foam particles.CONCLUSION:Preoperative embolisation in the highly vascular tumour, such as nasopharyngeal angiofibroma, is very useful to reduce peri-operative complication of surgery. This procedure can reduce blood loss during resection of the tumour and gives better outcomes.

术前栓塞鼻咽纤维血管瘤的疗效分析

目的：探讨术前栓塞鼻咽部纤维血管瘤供血动脉的临床疗效。方法：采用Seldinger技术，超选择插管对肿瘤颈外供血动脉进行栓塞后1~3 d内手术切除。结果：12例患者，患侧颌内动脉供血9例，合并咽升动脉供血1例。双侧颌内动脉分支供血2例，患侧颌内动脉及颈内动脉分支供血1例；均未发生严重并发症；栓塞后11例完整手术切除，1例部分切除拟分期手术。术中平均出血约380 ml。结论：术前血管栓塞鼻咽部血管瘤可有效减少术中出血，并增加肿瘤切除率。 Objective: To investigate the clinical efficacy of pre-surgical embolization of nasopharyngeal angiofibroma. Methods: Using Seldinger technique, 12 cases with nasopharyngeal angiofibroma underwent superselective feeding arteries emboilization, and then 1 - 3 days later, the angiofibroma was cut. The intraoperative blood loss was recorded. Results: For the 12 cases, 9 cases of nasopharyngeal angiofibroma were supplied by single-side internal maxillary artery, and 1 case combined with ascending pharyngeal artery, the bilateral internal axillary artery was in 2 patients, and the same lateral axillary artery and the branches of the internal carotid artery was in 1 patient. No serious complication happened after embolization. After thrombosis, in 11 cases underwent complete surgical resection, 1 case was of resection to staging surgery. All lesions were radical removed. The average intraoperative blood loss was 380 ml. Conclusion: The pre-surgical embolization of nasopharyngeal angiofibroma can reduce the intraoperative blood loss and increase radical resected rate.

Endoscopic transnasal approach for nasopharyngeal angiofibroma without arterial embolism

To explore the feasibility of endoscopic resection without arterial embolism for nasopharyngeal angiofibroma and the strategy of decreasing the bleeding during the operation. The clinical data of twenty-five cases of nasopharyngeal angiofibroma were retrospective analyzed, including 3 cases of Radowski stageIIa, 5 cases of stageIIb, 4 cases of stageIIc and with 13 cases of stage IIIa. All cases did not receive the arterial embolism, and controlled hypotension were adopted under endoscopic transnasal approach during the tumor resection. Two cases were added the labiogingival incision. During the operation, under the opening vision, cutting out the outside of the infratemporal fossa, and the pterygoid process to adequate exposure the pterygopalatine fossa and infratemporal fossa.Early recognition of anatomical landmarks and establish the safety plane, along the periphery of the tumor to proceed with micro-separation, early blocking tumor nutrient vessels, en bloc resection of the tumor and some other ways to reduce bleeding and tumor resection. Amount of bleeding during operation was 600-1500 ml, none of them had internal carotid artery injury and intracranial injury or some other complication.Follow-up 2-3 years was available in all patients, except 1 case with residual of tumor surrounding the optic nerve, the other 24 cases had no residual tumor and relapses. The preoperative occlusion and artery ligation may not be needed.Surgical technique is the key to reduce blood loss, and it is feasible to have endoscopic resection of nasopharyngeal angiofibroma with proper operating technique.

自己血輸血が有用であった鼻咽腔血管線維腫の２例

Nasopharyngeal angiofibroma is a benign and highly vascular tumor common in adolescent males. We report two cases of nasopharyngeal angiofibroma. One case was a 17-year-old male, and the other case was a 27-year-old male. One case complained of left nasal obstruction and recurrent epistaxis of the left nostril, and the other case complained only one epistaxis of right nostril.We found large masses filling the choanal cavity and CT scans and MRI images revealed that in both cases, tumors filled the nasopharyngeal cavity, the in one case the tumor extended into the left sphenopalatine fossa, and in the other case it extended into the right sphenoid sinus. Both cases underwent preoperative embolization with gelform one day before surgery and auto-transfusion was performed. In both cases, complete tumor removal was accomplished with a blood loss of 1300 and 1500ml. Nasopharyngeal angiofibroma is such a highly vascular tumor that we shoud perform auto-transfusion in spite of preoperative embolization.

A few points in the management of juvenile nasopharyngeal angiofibroma.

A few points based on our experience on 100 cases of nasopharyngeal angiofibroma are described, which are found very useful in the successful removal of nasopharyngeal fibroma. A new technique for the control of haemorrhage by a muscle graft immediately after the removal of an angiofibroma is advocated.

Two Cases of Nasopharyngeal Angiofibroma —Effect of Preoperative Transarterial Embolization—

Recently, two cases of nasopharyngeal angiofibroma were experienced. We emphasized in this paper that polytomography, computed tomography scan and angiography are necessary for preoperative evaluation of locating the lesion and delineating the vascular supply. An important problem in surgical treatment is massive bleeding, and the transarterial embolization is helpful to diminish it.