Role of Transarterial Preoperative Embolisation in the Management of Juvenile Nasopharyngeal Angiofibroma: A Prospective Interventional Study

Introduction: Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign yet highly vascular tumour that primarily affects adolescent males. Surgical resection is the standard treatment; however, it is often associated with significant intraoperative blood loss and increased morbidity. Preoperative Transarterial Embolisation (TAE) has emerged as an adjunctive procedure to minimise vascularity, thereby reducing surgical complications. Aim: To evaluate the impact of preoperative embolisation of JNA on the surgical outcome including intraoperative blood loss, intraoperative time and Intensive Care Unit (ICU) admissions in North Eastern India. Materials and Methods: The hospital-based prospective interventional study was conducted in the Department of Radiology at Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India, from November 2023 to October 2024 on 50 patients diagnosed with JNA and referred for preoperative embolisation from the Departments of Ear, Nose and Throat (ENT) and Paediatrics. Patients underwent Contrast Enhanced Computed Tomography (CECT) evaluation by the Philips Brilliance iCT 256 slice CT machine for staging (Radowski). Embolisation was done under the Siemens Artis Zee Biplane Digital Subtraction Angiography (DSA) machine by using Polyvinyl Alcohol (PVA) particles. Preoperative embolisation used PVA particles in all cases and parameters such as stage of tumour, grade of devascularisation, mean intraoperative blood loss, intraoperative time, postoperative complications and Intensive Care Unit (ICU) admission were obtained. These data were entered into Statistical Pacakge for Social Sciences (SPSS) software version 26.0 and Chi-square and Analysis of Variance (ANOVA) tests were applied. Results: The study included 50 patients (all males) aged 8 to 17 years with mean age of 14.18 years. In the present study, 6 patients (12.0%) were classified as stage IA JNA, while 18 patients (36.0%) had stage IB. All cases were embolised using PVA particles. The mean intraoperative blood loss was 246.16±110.18 mL. The mean operative time was 122.10±41.52 minutes. Mostly grade II devascularisation was achieved in the majority (58%) of patients. There was a significant association between grade of devascularisation and intraoperative blood loss, time and ICU admissions (p-value<0.05). No significant Post-embolisation complications were encountered. Conclusion: Preoperative embolisation of nasopharyngeal angiofibroma is a safe and effective technique to reduce intraoperative blood loss and reduce postoperative complications. Minor complications may be encountered, but major complications are rare if done using the correct technique.