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Juveniles Angiofibrom

Angiographische Diagnostik und präoperative Embolisation

Angiographic evaluation and embolization of juvenile nasopharyngeal angiofibroma

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Zusammenfassung

Hintergrund

Die der Operation vorgeschaltete Katheterangiographie mit anschließender selektiver intratumoraler Embolisation stellt ein etabliertes Verfahren in der Therapie des juvenilen Angiofibroms dar. Die hieraus resultierende verminderte Durchblutung des Tumors kann die vollständige Tumorentfernung erleichtern und zur Senkung der Rezidivrate beitragen. Im Rahmen dieser retrospektiven Studie sollen die angiographischen Befunde dargestellt und der Benefit der präoperativen Embolisation beleuchtet werden.

Patienten und Methoden

Die Befunde und der Krankheitsverlauf von 21 männlichen Patienten (mittleres Alter 13,3 Jahre) mit juvenilem Angiofibrom wurden aufgearbeitet. Es folgte die Angiographie und die intratumorale Embolisation mit Gelfoam-Partikel. Die Tumorexstirpation wurde transantral (n=2), über eine laterale Rhinotomie (n=13), via „midfacial degloving“ (n=4) oder endonasal (n=2) vorgenommen.

Ergebnisse

Bei 18 Patienten fand sich bei der Angiographie eine ausschließlich homolaterale Blutversorgung, bei 3 Patienten wurde der Tumor bilateral gespeist. Externa-Interna-Anastomosen wurden nicht festgestellt. Die intratumorale Embolisation gelang in allen Fällen. Es kam zu keinen relevanten Komplikationen. Der mittlere Blutverlust bei der Operation betrug 560 ml. Die Rezidivrate betrug 14%.

Schlussfolgerungen

Die präoperative angiographische Diagnostik und vor allem die intratumorale Embolisation sind wichtige Bestandteile bei der Planung des operativen Zugangsweges bei juvenilem Angiofibrom. Durch die Embolisation wird der intraoperative Blutverlust reduziert und das operative Vorgehen erleichtert.

Abstract

Objective

In juvenile nasopharyngeal angiofibroma (JNA), analysis of tumor extension and blood supply is useful for controlling intraoperative bleeding and helps in determining the appropriate surgical approach. The purpose of this study was to evaluate angiographic findings and the efficacy and benefits of preoperative embolization of JNA.

Patients and Methods

Twenty-one male patients with JNA (mean age 13.3 years) were included in this study. The tumors were embolized with particles of gel foam. Surgical removal was achieved through transantral approach (n=2), lateral rhinotomy (n=13), midfacial degloving (n=4), and endonasally (n=2).

Results

The blood supply was exclusively homolateral in 18 patients, deriving mainly from the external carotid artery, and bilateral in three. There were no connections between the branches of the internal and external carotid arteries. Intratumoral embolization was achieved in all patients. No major complications occurred. Mean blood loss during surgery was 560 ml. The recurrence rate was 14%.

Conclusion

Preoperative angiographic evaluation and embolization of JNA are important tools for planning surgical approach. Embolization reduces significantly the intraoperative blood loss, minimizes the need of blood transfusion, and makes resection easier.

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Authors and Affiliations

  1. Radiologisches Institut der Aristoteles-Universität Thessaloniki, AHEPA-Hospital, Griechenland

    C. Giavroglou & A. Dimitriadis

  2. Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie der Aristoteles-Universität, AHEPA-Hospital, , 54006, Thessaloniki

    J. Constantinidis, S. Triaridis & J. Daniilidis

Authors
  1. C. Giavroglou
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  2. J. Constantinidis
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  3. S. Triaridis
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  4. J. Daniilidis
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  5. A. Dimitriadis
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Correspondence to J. Constantinidis.

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Giavroglou, C., Constantinidis, J., Triaridis, S. et al. Juveniles Angiofibrom. HNO 55, 36–41 (2007). https://doi.org/10.1007/s00106-006-1410-y

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