Preoperative Embolization of Juvenile Nasopharyngeal Angiofibromas: Transarterial Versus Direct Tumoral Puncture

Objective: Preoperative embolization of juvenile nasopharyngeal angiofibromas (JNAs) has been shown to reduce operative times and blood loss. While traditional transarterial (TA) embolization is commonly employed, direct tumoral puncture (DTP) has also been advocated as an alternative. We report our series of JNAs embolized with onyx and compare the two embolization techniques. Methods: We prospectively collected all JNAs embolized with onyx at our institution during a 20-month period. The fluoroscopy time, percent of tumor devascularization, periprocedural complications, and intraoperative blood loss were compared between the two groups. Results: A total of 10 patients with JNA underwent preoperative embolization via a TA route (n = 5) or DTP (n = 5). Mean fluoroscopy times were 50 minutes and 39 minutes in the TA and DTP groups, respectively. The mean percent tumor devascularization in the TA group was 77% compared with 93% in the DTP group. Intraoperative EBL in tumors embolized transarterially was higher than those embolized by DTP (862 cc vs. 412 cc); however, this difference did not reach statistical significance. There were no neurological complications related to the embolization procedures in either group. Conclusion: Embolization of JNAs with onyx can be performed safely by either method. Direct puncture is associated with shorter embolization procedure times and results in a greater degree of tumor devascularization. Although there was a trend toward lesser blood loss in patients embolized by DTP, it did not reach statistical significance in this small series. Larger series are needed to determine if the improved tumor penetration achieved with DTP translates into clinical benefit