1
|
Maeda-Anezaki M, Omura K, Mori R, Ishida K. Case of giant juvenile angiofibroma resected by external incision with temporary double balloon occlusion of the internal carotid artery by intraoperative endovascular treatment. BMJ Case Rep 2024; 17:e256731. [PMID: 38479825 PMCID: PMC10941159 DOI: 10.1136/bcr-2023-256731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
We report the first case of a juvenile nasal angiofibroma (JNA) fed by multiple arteries from the internal carotid artery (ICA), removed without complications by temporarily blocking the ICA with two balloons. An early adolescent with JNA underwent preoperative embolisation of feeding arteries arising from the external carotid artery (ECA) (University of Pittsburgh Medical Centre classification IV). Endoscopic resection was attempted once but discontinued due to massive bleeding (7000 mL). 17 months later, the JNA had grown to fill both nasal cavities. Repeated preoperative embolisation of the feeders from the ECA was performed, followed by surgery combined with endoscopic and external incision. Intraoperatively, two balloons were inserted into the right ICA, which were inflated at the proximal and distal sites of the feeder vessels to cut-off blood flow to the tumour. The tumour was almost completely resected with 6270 mL of blood loss and no postoperative neurological deterioration.
Collapse
Affiliation(s)
- Mayuka Maeda-Anezaki
- Otorhinolaryngology, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
- Otorhinolaryngology, Self Defence Forces Central Hospital, Setagaya-ku, Tokyo, Japan
| | - Kazuhiro Omura
- Otorhinolaryngology, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Ryosuke Mori
- Neurosurgery, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Katsuhiro Ishida
- Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
| |
Collapse
|
2
|
Maeda M, Omura K, Kan I, Sano T, Nomura K, Takeda T, Ishibashi T, Otori N. Application of Digital Subtraction Angiography in Predicting the Outcomes of Intraoperative Hemorrhage of Juvenile Nasopharyngeal Angiofibroma. World Neurosurg 2023; 178:e339-e344. [PMID: 37480988 DOI: 10.1016/j.wneu.2023.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS The mean age was 20.8 ± 7.7 years. 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 ± 2568 mL. 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Mayuka Maeda
- Department of Otolaryngology and Head and Neck Surgery, Self-Defense Forces Central Hospital, Setagaya-ku, Tokyo, Japan; Department of Otolaryngology, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Kazuhiro Omura
- Department of Otolaryngology, The Jikei University Hospital, Minato-ku, Tokyo, Japan.
| | - Issei Kan
- Department of Neurosurgery, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Toru Sano
- Department of Neurosurgery, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku University, Sendai, Miyagi, Japan
| | - Teppei Takeda
- Department of Otolaryngology, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Nobuyoshi Otori
- Department of Otolaryngology, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| |
Collapse
|
3
|
Kothari DS, Linker LA, Tham T, Maroda AJ, McElfresh JM, Fastenberg JH, Hachem RA, Elijovich L, Michael LM, Rangarajan SV. Preoperative Embolization Techniques in the Treatment of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review. Otolaryngol Head Neck Surg 2023; 169:454-466. [PMID: 36808756 DOI: 10.1002/ohn.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/20/2022] [Accepted: 01/16/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Preoperative embolization has proven beneficial in the surgical treatment of juvenile nasopharyngeal angiofibromas (JNA). However, the consensus for the best embolization practices remains unclear. This systematic review seeks to characterize the reporting of embolization protocols throughout the literature and to compare differences in surgical outcomes. DATA SOURCES PubMed, Embase, and Scopus. REVIEW METHODS Studies investigating embolization in the treatment of JNA from 2002 to 2021 were selected from defined inclusion criteria. All studies underwent a 2-stage blinded screening, extraction, and appraisal process. Embolization material, time to surgery, and embolization route were compared. Embolization complications, surgical complications, and rate of recurrence were pooled. RESULTS Of 854 studies, 14 retrospective studies with 415 patients met the criteria for inclusion. A total of 354 patients underwent preoperative embolization. A total of 330 patients (93.2%) underwent transarterial embolization (TAE) and 24 patients had a combination of direct puncture embolization and TAE. Polyvinyl alcohol particles were the most used embolization material (n = 264, 80.0%). The most common reported time to surgery was 24 to 48 hours (n = 8, 57.1%). Pooled results showed an embolization complication proportion of 3.16% (95% confidence interval [CI]: 0.96-6.60) (n = 354), a surgical complication proportion of 4.96% (95% CI: 1.90-9.37) (n = 415), and a recurrence proportion of 6.30% (95% CI: 3.01-10.69) (n = 415). CONCLUSION The current data on JNA embolization parameters and their effect on surgical outcomes remains too heterogenous to provide expert recommendations. Future studies should use uniform reporting to allow for more robust comparisons of embolization parameters, which, in turn, may lead to optimized patient outcomes.
Collapse
Affiliation(s)
- Dhruv Shreedhar Kothari
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lauren A Linker
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tristan Tham
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Andrew J Maroda
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jenessa M McElfresh
- Department of Research and Learning Services, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Judd H Fastenberg
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Lucas Elijovich
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lattimore Madison Michael
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sanjeet V Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
4
|
Das KN, Sharma V, Tiwari S, Goyal A. An Unexpected Cause of Catastrophic Bleeding During Juvenile Nasopahryngeal Angiofibroma Excision. Indian J Otolaryngol Head Neck Surg 2023; 75:2403-2405. [PMID: 37636689 PMCID: PMC10447342 DOI: 10.1007/s12070-023-03695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023] Open
Abstract
We describe the first case of juvenile nasopharyngeal angiofibroma receiving blood supply from caroticotympanic artery which resulted in catastrophic bleeding intraoperatively. The patient was an 12-year-old boy with a Radkowski stage 3B JNA. We utilized preoperative embolization of feeders from external carotid artery though the surgeon failed to excise the tumor completely due to uncontrollable bleeding from the tumor. On retrospective analysis of angiography only the culprit feeder found. Tumor was excised in the second surgery conducted a week later. Although selective embolization of ICA branches are described in literature the data are sparse and so is the management of such cases.
Collapse
Affiliation(s)
- K. Nidhin Das
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhu Sharma
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| |
Collapse
|
5
|
Liu Q, Xia Z, Hong R, Pan Y, Xue K, Liu Q, Sun X, Li H, Sha Y, Yu H, Wang D. Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary? Cardiovasc Intervent Radiol 2023; 46:1038-1045. [PMID: 37430013 DOI: 10.1007/s00270-023-03483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/26/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To determine the effects of blood supply from internal carotid artery (ICA) on the surgical outcomes of primary juvenile nasopharyngeal angiofibroma (JNA) after transarterial embolization (TAE). METHODS A retrospective analysis was performed on primary JNA patients who underwent TAE and endoscopic resection in our hospital between December 2020 and June 2022. The angiography images of these patients were reviewed, and then they were divided into ICA + external carotid artery (ECA) feeding group and ECA feeding group according to whether the ICA branches were part of the feeding arteries. Tumors in ICA + ECA feeding group were fed by both ICA and ECA branches, while tumors in ECA feeding group were fed by ECA branches alone. All patients underwent tumor resection immediately after ECA feeding branches embolization. None of the patients underwent ICA feeding branches embolization. Data on demographics, tumor characteristics, blood loss, adverse events, residual and recurrence were collected, and case-control analysis was performed for the two groups. Differences in characteristics between the groups were tested using Fisher's exact and Wilcoxon tests. RESULTS Eighteen patients were included in this study: nine in ICA + ECA feeding group and nine in ECA feeding group. The median blood loss was 700 mL (IQR 550-1000 mL) in ICA + ECA feeding group versus 300 mL (IQR 200-1000 mL) in ECA feeding group, with no significant statistical difference (P = 0.306). Residual tumor was found in one patient (11.1%) in both groups. Recurrence was not observed in any patient. There were no adverse events from embolization and resection in either group. CONCLUSION The results of this small series suggest that the presence of blood supply from ICA branches in primary JNA has no significant effect on intraoperative blood loss, adverse event, residual and postoperative recurrence. Therefore, we do not recommend routine preoperative embolization of ICA branches. LEVEL OF EVIDENCE Level 4, Case-control.
Collapse
Affiliation(s)
- Qiang Liu
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Zhipeng Xia
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Rujian Hong
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Yucheng Pan
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Kai Xue
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Quan Liu
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Xicai Sun
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Houyong Li
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yan Sha
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Dehui Wang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| |
Collapse
|
6
|
Diaz A, Wang E, Bujnowski D, Arimoto R, Armstrong M, Cyberski T, Nordgren R, Seal SM, Kass-Hout T, Roxbury C. Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta-Analysis. Laryngoscope 2023. [PMID: 36789781 DOI: 10.1002/lary.30616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To compare outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non-embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE). DATA SOURCES Per PRISMA guidelines, PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched for publications prior to or in 2021. MATERIALS AND METHODS Original English manuscripts investigating the resection of JNA with and without preoperative embolization were included. Embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Risk of bias was assessed by the Risk of Bias in Non-randomized Studies-of Interventions method. RESULTS There were 61 studies with 917 patients included. Preoperative embolization was performed in 79.3% of patients. Of those embolized, 75.8% (N = 551) underwent TAE and 15.8% (N = 115) underwent DPE. JNA recurrence in embolized patients was lower than in non-embolized patients (9.3% vs. 14.4%; odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.35, 1.06). DPE resulted in lower rates of disease recurrence (0% vs. 9.5%; OR: 0.066, 95% CI: 0.016, 0.272) and complications (1.8% vs. 21.9%; OR: 0.07, 95% CI: 0.02, 0.3) than TAE. A random effects Bayesian model was performed to analyze the difference in mean blood loss in 6 studies that included both embolized and non-embolized patients. This analysis showed a mean reduction in blood loss of 798 mL in the embolized group. CONCLUSIONS We found embolization decreases blood loss in JNA resection. DPE led to improved recurrence and complication rates when compared to TAE, but future prospective studies are needed to further evaluate which embolization technique can optimize outcomes in JNA. LEVEL OF EVIDENCE NA Laryngoscope, 2023.
Collapse
Affiliation(s)
- Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Esther Wang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Daniel Bujnowski
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Ryuji Arimoto
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Mikhayla Armstrong
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Thomas Cyberski
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Stella M Seal
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Christopher Roxbury
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|
7
|
Liu Q, Li W, Hong R, Pan Y, Xue K, Liu Q, Sun X, Li H, Sha Y, Yu H, Wang D. Preoperative Transarterial Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma Using n-Butyl Cyanoacrylate: Case-Control Comparison with Microspheres. J Vasc Interv Radiol 2023; 34:856-864.e1. [PMID: 36681112 DOI: 10.1016/j.jvir.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of transarterial embolization (TAE) with n-butyl cyanoacrylate (nBCA) for juvenile nasopharyngeal angiofibroma (JNA). MATERIALS AND METHODS A retrospective review was performed on patients with JNA who underwent TAE and endoscopic resection between 2020 and 2022. Patients embolized with nBCA were identified, and those embolized with microspheres were set as the control group. Data on demographics, symptoms, tumor characteristics, blood loss, adverse events, residual disease, and recurrence were collected, and case-control analysis was performed for the 2 groups. Differences in characteristics between the groups were tested using the Fisher exact and Wilcoxon tests. A generalized linear model (GLM) was used to analyze the univariate and multivariate influences on blood loss. RESULTS Twenty patients were included in this study: 13 in the microsphere group and 7 in the nBCA group. The median blood loss was 400 mL (interquartile range [IQR], 200-520 mL) in the nBCA group and 1,000 mL (IQR, 500-1,000 mL) in the microsphere group (P = .028). The GLM confirmed lower blood loss in the nBCA group (relative risk, 0.58 [0.41-0.83]; P = .01). A residual tumor was found in 1 patient in each group (7.7% vs 14.3%; P = 1.000). Recurrence was not observed in any patient. None of the patients experienced adverse events during embolization. CONCLUSIONS TAE of advanced JNA with nBCA glue is safe and effective and can significantly reduce intraoperative blood loss compared with microspheres.
Collapse
Affiliation(s)
- Qiang Liu
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Wanpeng Li
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Rujian Hong
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yucheng Pan
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Kai Xue
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xicai Sun
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Houyong Li
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
8
|
Giorgianni A, Molinaro S, Agosti E, Terrana AV, Vizzari FA, Arosio AD, Pietrobon G, Volpi L, Turri-Zanoni M, Craparo G, Piacentino F, Castelnuovo P, Baruzzi FM, Bignami M. Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate. J Clin Med 2021; 10:jcm10173926. [PMID: 34501374 PMCID: PMC8432214 DOI: 10.3390/jcm10173926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.
Collapse
Affiliation(s)
- Andrea Giorgianni
- Neuroradiology Unit, ASST Sette Laghi-Circolo Hospital, 21100 Varese, Italy; (A.G.); (A.V.T.); (F.A.V.); (F.M.B.)
| | - Stefano Molinaro
- Neuroradiology Unit, ASST Sette Laghi-Circolo Hospital, 21100 Varese, Italy; (A.G.); (A.V.T.); (F.A.V.); (F.M.B.)
- Correspondence:
| | - Edoardo Agosti
- Department of Biotechnology and Life Sciences, Division of Neurosurgery, University of Insubria, 21100 Varese, Italy;
| | - Alberto Vito Terrana
- Neuroradiology Unit, ASST Sette Laghi-Circolo Hospital, 21100 Varese, Italy; (A.G.); (A.V.T.); (F.A.V.); (F.M.B.)
| | - Francesco Alberto Vizzari
- Neuroradiology Unit, ASST Sette Laghi-Circolo Hospital, 21100 Varese, Italy; (A.G.); (A.V.T.); (F.A.V.); (F.M.B.)
| | - Alberto Daniele Arosio
- Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, 21100 Varese, Italy; (A.D.A.); (M.T.-Z.); (P.C.)
- Department of Surgical Specialities, Division of Otorhinolaryngology, ASST Sette Laghi-Circolo Hospital, 21100 Varese, Italy
| | - Giacomo Pietrobon
- Department of Head and Neck Surgery and Otorhinolaryngology, European Institute of Oncology IRCCS, 20122 Milano, Italy;
| | - Luca Volpi
- Department of Otorhinolaryngology, ASST Lariana, University of Insubria, 22100 Como, Italy; (L.V.); (M.B.)
- Department of Surgery, ASST Lariana, University of Insubria, 22100 Como, Italy
| | - Mario Turri-Zanoni
- Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, 21100 Varese, Italy; (A.D.A.); (M.T.-Z.); (P.C.)
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Giuseppe Craparo
- Diagnostic and Interventional Neuroradiology Unit, ARNAS Civic Hospital, 90127 Palermo, Italy;
| | | | - Paolo Castelnuovo
- Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, 21100 Varese, Italy; (A.D.A.); (M.T.-Z.); (P.C.)
- Department of Surgical Specialities, Division of Otorhinolaryngology, ASST Sette Laghi-Circolo Hospital, 21100 Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Fabio Massimo Baruzzi
- Neuroradiology Unit, ASST Sette Laghi-Circolo Hospital, 21100 Varese, Italy; (A.G.); (A.V.T.); (F.A.V.); (F.M.B.)
| | - Maurizio Bignami
- Department of Otorhinolaryngology, ASST Lariana, University of Insubria, 22100 Como, Italy; (L.V.); (M.B.)
- Department of Surgery, ASST Lariana, University of Insubria, 22100 Como, Italy
| |
Collapse
|