Investigation of vascularization patterns in juvenile Angiofibroma and the impact of preoperative embolization on surgical excision

Abstract

Background

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, highly vascular tumor posing a significant challenge for endoscopic excision due to excessive intraoperative bleeding. Exploring feeding vessels and preoperative embolization could reduce intraoperative blood loss and improve surgical outcomes for JNA. This study investigates the vascularization patterns of JNA and the impact of preoperative embolization on surgical excision.

Methods

This was a descriptive cross-sectional study of 30 histopathologically confirmed JNA patients who underwent preoperative embolization followed by endoscopic surgical excision from January 2019 to May 2023 at Ear Nose Throat Hospital of Ho Chi Minh City. The distribution of vascular supply of tumors, as well as the role of preoperative embolization, were analyzed.

Results

Most tumors received exclusive blood supply from the internal maxillary artery (IMA) accounting for 50%, with 20% of cases being supplied by bilateral IMAs. A combined supply pattern involving the IMA and other external carotid artery branches was observed in 26.6%. Three complex cases (10%) received blood from the internal carotid artery (ICA). Embolization was performed at branches originating from the external carotid artery (ECA) but not from the ICA to avoid complications. All patients achieved complete endoscopic JNA excision. The average intraoperative blood loss was 608 mL (range: 100 mL - 3000 mL), and the average Boezaart score was 2.63. No major surgical complications occurred in the perioperative period. Significant differences in blood loss were observed among different UPMC tumor stages (p < 0.001) and tumor sizes (p = 0.008). Advanced-stage tumors were more likely to have an ICA blood supply (p = 0.038).

Conclusion

Understanding the vascularization patterns of juvenile angiofibroma and the role of preoperative embolization can facilitate endoscopic excision of these tumors.