Le fibrome nasopharyngien : à propos de 15 cas traités par embolisation

Presurgical embolization of nasopharyngeal fibroma: A case report

Nasopharyngeal fibroma (NF) is a rare nasopharyngeal tumor of a benign histological nature but with local aggressiveness. It is a hypervascular tumor and the main feeding artery comes from the internal maxillary artery. Surgery is the treatment of choice for this tumor but carries a significant risk of bleeding from surgical treatment. Thus, embolization carried out preoperatively effectively reduces intraoperative bleeding and thereby allows complete resection for large tumors.

Bilateral non-superselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note

Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.

Juvenile nasopharyngeal angiofibroma with intracranial extension

OBJECTIVE

To provide a critical evaluation of the historical evolution of the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) with intracranial extension.

STUDY DESIGN

Case series with chart review.

SETTING

Skull base multidisciplinary group at the Instituto de Neurologia de Curitiba, Brazil.

SUBJECTS AND METHODS

From 1988 to 2000, the multidisciplinary skull base group surgically treated 67 adolescent boys with JNA, 20 of whom presented with intracranial extension. All patients presented involvement of the cavernous sinus, and 5 of them spread into the orbit. Before 2008, the authors combined microscopic-endoscopic techniques. After this period, the surgical approach used was facial degloving, associated with purely endoscopic technique patients.

RESULTS

Total tumor removal was achieved in 17 cases in the first surgery. In this series, the intracranial extension was extradural in all cases. There was only 1 case of cerebrospinal fluid leakage, which was promptly identified and treated. There was no mortality or permanent morbidity.

CONCLUSION

Radical removal of large JNA may be difficult because of its extreme vascularity and extension to the cavernous sinus, orbit, middle and anterior fossa. Nevertheless, most of JNA with intracranial extension can be resected in the first operation with minimal morbidity through a facial degloving and further combination of expanded endoscopic endonasal approaches.