Application of DSA and embolization for vascular lesions in otorhinolaryngology-head and neck surgery

Objective To evaluate the application value of digital subtraction angiography( DSA) and embolization on diagnostic and treatment for vascular diseases in otorhinolaryngology-head and neck surgery. Methods The clinical data of 35 patients including 27 cases of nasopharyngeal angiofibroma,4 cases of maxillary sinus aneurysm and 4 cases of refractory epistaxis( containing 1 case of spontaneous internal carotid cavernous fistula complicated with nasal massive hemorrhage and 1 case of nasopharyngeal carcinoma complicated with refractory epistaxis after radiotherapy) were retrospectively analyzed. The diagnosis and treatment were carried out by DSA and embolization using transarterial catheterization with seldinger technique. The applied value of DSA and embolization in these diseases was analyzed. Results The DSA and embolization succeeded in all the patients. Among 5 cases treated by simple embolization,the healing only once was seen in 1 case of internal carotid cavernous fistula and other 3 cases of refractory epistaxis,and in the other 1 case of nasopharyngeal angiofibroma,the tumor volume was obviously decreased( confirmed by image examination) after performing palliative embolization only owing to extensive destruction of base of skull and internal carotid artery blood-supply. In the rest of 26 cases of nasopharyngeal angiofibroma and4 cases of maxillary sinus aneurysm,the operations were all performed after embolization; in them,the intra-operative bleeding volume decreased obviously with mean bleeding volume of 470 ml in 28 cases; 2 cases of nasopharyngeal angiofibroma Ⅳ stage with both internal and external carotid arteries blood-supply had more intra-operative bleeding volume owing to performing embolization of external carotid only. Conclusions DSA can clearly show dynamic images of blood-supply artery,abnormal communicating branch and arterio-venous fistula in the head-neck vascular lesions and guide the choice of therapeutic method. Intravascular embolization has good therapeutic effect to refractory epistaxis of external carotid system and internal carotid cavernous fistula,and preoperative embolization can obviously decrease intra-operative bleeding and enhance safety of operation immensely for tumors with rich blood supply and needing surgery.