Primary Preoperative Coil Embolization of a Juvenile Nasopharyngeal Angiofibroma: A Minimally Invasive Strategy to Reduce Surgical Blood Loss

Abstract

A teenage patient with recurrent right-sided epistaxis was found to have a juvenile nasal angiofibroma (JNA). Preoperative coil embolization was performed to reduce surgical blood loss. Angiography revealed tumor blush primarily supplied by the right internal maxillary and ascending pharyngeal arteries, which were selectively catheterized and embolized using detachable coils. Additional supply from the left internal maxillary artery was also treated. The ability to retract and reposition coils and partially prolapse them into adjacent small branches allowed broad tumor coverage without individually catheterizing each branch, thereby reducing both procedure time and radiation exposure. Postembolization angiography showed minimal residual vascularity, and the patient underwent surgical resection the following day with an estimated blood loss of 100 mL. He was discharged without complications. This case demonstrates the effectiveness of coil embolization in devascularizing JNAs while minimizing off-target embolization and reducing operative blood loss.

Keywords

juvenile nasopharyngeal angiofibroma - preoperative embolization - coil embolization - nasopharyngeal tumors - tumor devascularization - external carotid artery embolization

Ethical Approval Statement

Approval was obtained from the institutional review board, with a waiver of informed consent due to its retrospective design.

Publikationsverlauf

Eingereicht: 27. Juli 2025

Angenommen: 08. September 2025

Artikel online veröffentlicht:
26. Dezember 2025

• References

• 1 López F, Triantafyllou A, Snyderman CH. et al. Nasal juvenile angiofibroma: current perspectives with emphasis on management. Head Neck 2017; 39 (05) 1033-1045
• 2 Diaz A, Wang E, Bujnowski D. et al. Embolization in juvenile nasopharyngeal angiofibroma surgery: a systematic review and meta-analysis. Laryngoscope 2023; 133 (07) 1529-1539
• 3 Lutz J, Holtmannspötter M, Flatz W. et al. Preoperative embolization to improve the surgical management and outcome of juvenile nasopharyngeal angiofibroma (JNA) in a single center: 10-year experience. Clin Neuroradiol 2016; 26 (04) 405-413
• 4 Coutinho-Camillo CM, Brentani MM, Nagai MA. Genetic alterations in juvenile nasopharyngeal angiofibromas. Head Neck 2008; 30 (03) 390-400
• 5 Choi JS, Yu J, Lovin BD, Chapel AC, Patel AJ, Gallagher KK. Effects of preoperative embolization on juvenile nasopharyngeal angiofibroma surgical outcomes: a study of the kids' inpatient database. J Neurol Surg B Skull Base 2020; 83 (01) 76-81
• 6 Liu Q, Li W, Hong R. et al. Preoperative transarterial embolization of advanced juvenile nasopharyngeal angiofibroma using n-butyl cyanoacrylate: case-control comparison with microspheres. J Vasc Interv Radiol 2023; 34 (05) 856-864.e1
• 7 Giorgianni A, Molinaro S, Agosti E. et al. Twenty years of experience in juvenile nasopharyngeal angiofibroma (JNA) preoperative endovascular embolization: an effective procedure with a low complications rate. J Clin Med 2021; 10 (17) 3926
• 8 Kothari DS, Linker LA, Tham T. et al. Preoperative embolization techniques in the treatment of juvenile nasopharyngeal angiofibroma: a systematic review. Otolaryngol Head Neck Surg 2023; 169 (03) 454-466
• 9 Gemmete JJ, Patel S, Pandey AS. et al. Preliminary experience with the percutaneous embolization of juvenile angiofibromas using only ethylene-vinyl alcohol copolymer (Onyx) for preoperative devascularization prior to surgical resection. AJNR Am J Neuroradiol 2012; 33 (09) 1669-1675
• 10 Ballah D, Rabinowitz D, Vossough A. et al. Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre. Clin Radiol 2013; 68 (11) 1097-1106