Pamela Zengel, Abstract Co-Author: Nothing to Disclose

Juergen Lutz MD, Presenter: Nothing to Disclose

Wilhelm Harald Flatz MD, Abstract Co-Author: Nothing to Disclose

Alexander Berghaus MD, PhD, Abstract Co-Author: Nothing to Disclose

Rene Chapot MD, PhD, Abstract Co-Author: Nothing to Disclose

Hartmuth Brueckmann, Abstract Co-Author: Nothing to Disclose

Markus Holtmannspoetter, Abstract Co-Author: Nothing to Disclose

Aim of the study was to evaluate the efficacy and safety of preoperative Onyx embolization via direct puncture in comparison with standard preoperative endovascular embolization with polyvinyl alcohol (PVA) microparticles in Juvenile Nasopharyngeal Angiofibroma (JNA).

Eleven patients between 11-16 years (median age 13 years) with a diagnosis of JNA referred for preoperative embolization during 2005 and 2009 were retrospectively analyzed. The information on tumor type, location, extent of tumor devascularization, endovascular and surgical complications, intraoperative blood loss, and rate of recurrence was evaluated. Preoperative angiography with transarterial embolization using PVA microparticles was performed on seven patients and intratumoral Onyx injections were performed in four cases via direct tumor puncture. Punctures were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Subsequently, a comparison was made between patients who had undergone Onyx versus endovascular PVA embolization. All patients underwent surgery, using two main different surgical approaches, endoscopic vs. Midfcaial degloving.  

Our study demonstrate that Onyx embolization was associated with a shorter surgical procedure duration as well as more accurate mass identification, due to the black color and the radiopacity of the Onyx embolisat. The patients embolized with Onyx needed no further intervention following the operation, whereas those embolizated with polyvinyl alcohol (PVA) microparticles required further intervention. There was one adverse event in the Onyx embolization group resulting in temporary antikoagulation therapy.      

The direct tumor embolization with Onyx is a feasible, safe, and highly effective procedure for reduction of adverse effects of performing the surgical procedure as well as improving the clinical outcome of  patients with Juvenile Angiofibroma (JNA)  

Our study provides preliminary data, suggesting embolization with Onyx via direct tumoral puncture in patients with JVA has several advantages concerning patients safety during angiography and surgery

Zengel, P, Lutz, J, Flatz, W, Berghaus, A, Chapot, R, Brueckmann, H, Holtmannspoetter, M, Preoperative Onyx Embolization and Devascularization via Direct Tumor Puncture to Improve the Surgical Management of Juvenile Nasopharyngeal Angiofibroma (JNA)  .  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007862.html