Targeted Approach to Ligation of Feeding Vessels Based on Preoperative Imaging in Resection of Juvenile Nasopharyngeal Angiofibroma Obviating Preoperative Embolization

Objective: Juvenile Nasopharyngeal Angiofbroma (JNA) is a benign, yet locally aggressive tumor with a rich blood supply. Surgical management is the mainstay treatment for JNA, however, blood loss is a big concern during surgery. This retrospective study aims to evaluate the efcacy of ligating the feeding vessels of JNA based on preoperative imaging, potentially eliminating the need for preoperative embolization.

Methods: We retrospectively analyzed the medical records of 380 patients who underwent surgery for JNA at our tertiary care, high volume center, without prior embolization. Preoperative scans were reviewed to identify the location of feeding vessels. Surgical techniques were adapted to ligate the major feeding vessel(s) identifed preoperatively. Intraoperative blood loss was meticulously recorded.

Results: In the 380 patients, the mean blood loss increased with advancing disease stage. The average blood loss across all stages was 635.54 mL. This observed blood loss was signifcantly lower compared to data published by other studies that employed preoperative embolization for blood loss reduction.

Conclusion: Preoperative evaluation of imaging for feeding vessel localization accurately correlated with intraoperative fndings. Ligation of identifed feeding vessels might eliminate the need for preoperative embolization in JNA surgery.

Cite this article as: Trichy Narayanan J, Venkatramanan MAR, Sampath S, G Arun Kumar, Rajalingam B. Targeted approach to ligation of feeding vessels based on preoperative imaging in resection of juvenile nasopharyngeal angiofbroma obviating preoperative embolization. Eur J Rhinol Allergy 2024;7(1):8-13.