Adjunctive embolization for juvenile nasopharyngeal angiofibroma

Objective To report our experience of adjunctive embolization for juvenile nasopharyngeal angiofibroma(JNA),especially double embolization.Methods Fourteen cases(male,age range 11—17 years old)were comprised of this study group.Type Ⅰ was 1 cases,type Ⅱ 1 cases,type Ⅲ 8 cases and type Ⅳ 4 cases.In the two cases of type Ⅰ and Ⅱ without blood supply of internal carotid artery,polyvinyl alcohol(PVA)embolization of internal maxillary artery were only indicated.In the other 12 cases with blood supply of internal carotid artery and involvement of infratemporal fossa and skull base,percutaneous puncture N-butyl cyanoacrylate(NBCA)embolization combined with endovascular PVA embolization of the internal maxillary artery was performed.Results JNA were demonstrated abnormal vessel blush in the carotid angiography,the main blood supply came from the internal maxillary artery,and the internal carotid artery also supply it when the infratemporal fossa and skull base were invaded.Obvious loss of bleeding was achieved during JNA excision procedure post-embolization.Conclusions Adjunctive embolization for JNA is necessary.Percutaneous puncture NBCA embolization combined endovascular PVA embolization of the internal maxillary artery(double embolization)was indicated in the patients with involvement of infratemporal fossa and cranial base.