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Preoperative emobilisation of juvenile nasopharyngeal angiofibroma.

Authors:
Ravi Meher Sanjeev Kathuria Vikram Wadhwa Mohamed Riyas Ali Bhushan Shah Ankit Bansal Prakhar Goel

Am J Otolaryngol 2022 Jun 11;43(5):103532. Epub 2022 Jun 11.

ENT, Maulana Azad Medical College, India.

Introduction: Juvenile nasopharyngeal angiofibroma(JNA) are highly vascular benign tumours originating in the sphenopalatine fossa and may extend to the pterygopalatine fossa, paranasal sinuses, and nasal cavity. The management of JNA has evolved greatly with development of endoscopy. Treatment modality has changed from open approach to endoscopic approach due to various advantages offered by the endoscopic approach. Bleeding during the surgery can compromise the exposure and surgical excision of JNA endoscopically. There have been many techniques to decrease intraoperative bleeding including external carotid ligation, hypotensive anaesthesia and more recently embolization of the feeding vessels. Embolization of the tumour has made the endoscopic excision of JNA easier because of less bleeding. This study was taken to find out the outcomes of surgical excision of JNA after embolization.

Methodology: We retrospectively reviewed 22 histopathological proven JNA cases that underwent preoperative embolization followed by resection during the period of June 2015 to December 2020 in our tertiary care hospital. From the records demographic, clinical, radiological imaging (CECT nose and PNS), angiographic, pre-operative embolization and operative details were evaluated.

Result: In the present study a total of 22 cases of angiofibroma were taken up for surgical excision after embolization. A complete endonasal endoscopic resection could be done in 21/22 cases with average operative time of 141 minutes (80 minutes-190 minutes range). The mean blood loss during surgery was 1163 ml (Range 500 ml- 1900 ml). In 7/22 (31.81%) subjects required intraoperative blood transfusion. No perioperative surgical complications occurred.

Conclusion: Endoscopic excision of JNA has now become the primary operative technique and pre operative embolization in such cases can reduce the intraoperative time, blood loss and tumour relapse rate. It is a relatively safe procedure in a hand of an expert and must be done where ever available.

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http://dx.doi.org/10.1016/j.amjoto.2022.103532DOI Listing
June 2022

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Preoperative emobilisation of juvenile nasopharyngeal angiofibroma.

Authors:
Ravi Meher Sanjeev Kathuria Vikram Wadhwa Mohamed Riyas Ali Bhushan Shah Ankit Bansal Prakhar Goel

Am J Otolaryngol 2022 Jun 11;43(5):103532. Epub 2022 Jun 11.

ENT, Maulana Azad Medical College, India.

Introduction: Juvenile nasopharyngeal angiofibroma(JNA) are highly vascular benign tumours originating in the sphenopalatine fossa and may extend to the pterygopalatine fossa, paranasal sinuses, and nasal cavity. The management of JNA has evolved greatly with development of endoscopy. Treatment modality has changed from open approach to endoscopic approach due to various advantages offered by the endoscopic approach. Read More

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Clin Nucl Med 2022 Mar;47(3):e268-e270

Pathology, All India Institute of Medical Sciences, New Delhi, India.

Abstract: We present the case of a left-sided recurrent juvenile nasopharyngeal angiofibroma (JNA) in a 16-year-old boy who underwent endoscopic excision 2 years back. The preoperative contrast-enhanced MRI and histopathology were in favor of JNA. The follow-up 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scan at 3-month interval revealed complete clearance of disease. Read More

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Biomedicine (Taipei) 2020 1;10(3):41-44. Epub 2020 Sep 1.

Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, hypervascular, benign tumor which is mainly seen among male adolescents. The tumor typically originates from the sphenopalatine fossa, but could spread through natural foramens and fissures. There are some reports of atypical growth of this tumor in literature but the intraluminal growth, which could be seen in paraganglioma and glomus tumors, has not reported yet in angiofibroma. Read More

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Clinical Utility of Ga-DOTANOC Positron Emission Tomography-Computed Tomography Scan on Postoperative Assessment of Juvenile Nasal Angiofibroma.

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Pirabu Sakthivel Alok Thakar Arun Prashanth Sreedharan Thankarajan Arunraj Rakesh Kumar Rakesh Kumar

Indian J Nucl Med 2020 Oct-Dec;35(4):372-373. Epub 2020 Oct 21.

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Somatostatin cell surface receptors are expressed on the peritumoral vessels of various benign and malignant neoplasms including angiofibromas. Positive initial uptake on positron emission tomography-computed tomography (PET/CT) imaging with Ga-labeled DOTANOC is noted in a patient with juvenile nasal angiofibroma (JNA), and the same is noted to be absent following complete surgical excision. Functional Ga-DOTANOC PET/CT may be an early useful tool for JNA residual/recurrence identification and precise postoperative surveillance. Read More

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Clin Nucl Med 2020 Dec;45(12):e498-e504

Nuclear Medicine.

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