Juvenile Nasopharyngeal Angiofibroma with Skull Base Invasion: Intratumoral Direct Puncture Embolization

ABSTRACT

PURPOSE: To demonstrate the utility and efficacy of percutaneous direct glue embolization for juvenilenasopharyngeal angiofibromas with skull base invasion MATERIALS AND METHODS: In nine cases of juvenilenasopharyngeal angiofibromas with invasion of the skull base, embolization under general anethesia was performed.Using an 18G spinal needle, direct puncture were made via the transnasal or mandibular sciatic notch. Aglue-lipiodol mixture (11-13) was injected slowely for 15 to 30 seconds under fluoroscopic control; the numberof injections depended on the size of the tumoral compartment. The results were evaluated by post-embolizationangiography and the distribution of embolic materials was assessed on CT within 1-3 days. The mass was surgicallyremoved 3 to 7 days after embolization. RESULTS: Postembolization angiography revealed total devascularization insix cases, and devascularization greater than 90% of the initial volume in the remaining three. The cast of thetumor was clearly demonstrated by the embolization material with increased density. Surgical removal was safelyperformed without significant bleeding. And no neurologic complications were observed. CONCLUSION: Direct glueembolization of juvenile angiofibroma with skull base invasion appears to be a simple and safe procedure. Thetechnique could be used for other hypervascular lesions in the base fo the skull or parapharyngeal space.