Interventional radiology management of juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma is a rare, highly vascular tumor that occurs almost exclusively in adolescent and young adult males and is associated with substantial intraoperative bleeding risk during surgical resection. Preoperative intra-arterial embolization is commonly performed to reduce tumor vascularity and improve perioperative safety. We present a case of a 21-year-old male with a history of asthma presenting with persistent unilateral nasal congestion who was found to have a left-sided nasopharyngeal mass. Surgical pathology later confirmed sinonasal angiofibroma. Diagnostic cerebral angiography demonstrated tumor blush supplied by branches of the left sphenopalatine artery arising from the internal maxillary artery of the external carotid circulation without significant contribution from the internal carotid artery or ophthalmic artery anastomoses. Using a microcatheter system, selective catheterization of the left sphenopalatine artery was performed, and embolization was achieved with 200-micrometer polyethylene glycol microspheres until near stasis was observed. Postembolization angiography demonstrated marked reduction of tumor blush, consistent with successful devascularization. The patient subsequently underwent successful surgical resection with remarkably low intraoperative blood loss (estimated 50 mL). This case highlights the role of interventional radiology in targeted preoperative embolization for the management of juvenile nasopharyngeal angiofibroma. Selective embolization of the sphenopalatine arterial supply can significantly reduce tumor vascularity and facilitate safer surgical resection with minimal blood loss. The relatively insidious clinical presentation and use of polyethylene glycol microspheres, which, to our knowledge, have not been previously described in juvenile nasopharyngeal angiofibroma, represent distinctive clinical and technical features of this case.