scholarly journals Geometric Alopecia after Preoperative Angioembolization of Juvenile Nasopharyngeal Angiofibroma

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0048 ◽  
Author(s):  
Alejandro Vazquez ◽  
Pratik A. Shukla ◽  
Osamah J. Choudhry ◽  
Chirag D. Gandhi ◽  
James K. Liu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Radiation Exposure ◽  
Skull Base ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma ◽  
Intraoperative Bleeding

Resection of a juvenile nasopharyngeal angiofibroma (JNA) is challenging because of high intraoperative blood loss secondary to the tumor's well-developed vascularity. Endoscopic sinus and skull base surgeons commonly collaborate with neurointerventionalists to embolize these tumors before resection in an attempt to reduce the vascular supply and intraoperative bleeding. However, angioembolization can be associated with significant complications. Geometric alopecia from angioembolization of JNA has not been previously reported in the otolaryngologic literature. In this study, we discuss geometric alopecia from radiation exposure during preoperative angioembolization of a JNA.

Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

2020 ◽  
Author(s):  
Ravi S. Manogaran ◽  
Arulalan Mathialagan ◽  
Vivek Singh ◽  
Prabhaker Mishra ◽  
Rajat Jain ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Tertiary Care ◽  
Three Dimensional ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Vascular Pattern ◽  
Nasopharyngeal Angiofibroma ◽  
Intraoperative Bleeding ◽  
Angiography And Embolization

Abstract Objectives This study was aimed to understand the usefulness of transarterial angiography and embolization in management of juvenile nasopharyngeal angiofibroma (JNA) and to apply the information obtained to stage the disease, select appropriate surgical approach, predict intraoperative bleeding, and prognosticate the disease. Design This study represents a retrospective review of the patients of JNA with major focus on transarterial angiography and embolization findings and its clinical and surgical implications. Setting The study conducted at a tertiary-care super-specialty referral center. Participants Forty-two patients who had undergone transarterial angiography and embolization followed by surgery over the period of 5 years from July 2015 till February 2019 were participated in this study. Main Outcome Measures Tumor vascular pattern based on transarterial angiography, staging of the disease based on extent and vascular supply, surgical approach selected, and prognosticating the disease were determined from this study. Conclusion Transarterial angiography with embolization becomes a prudent preoperative investigation for management of JNA. It provides a complete three-dimensional map of the tumor with stage-specific vascular pattern, reduces vascularity of the tumor, and predicts the sites from where bleeding can occur intra operatively. Thus, it helps in choosing the appropriate surgical approach aiding in complete tumor removal with minimal bleeding.

scholarly journals Management of Pterygoid Venous Plexus Hemorrhage during Resection of a Large Juvenile Nasopharyngeal Angiofibroma: A Review of 27 Cases

2013 ◽  
Vol 92 (5) ◽  
pp. 204-208
Author(s):  
Lin Chang ◽  
Yi Zixiang ◽  
Fang Zheming ◽  
Lin Gongbiao ◽  
Li Zhichun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Approach ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Imaging Data ◽  
Venous Plexus ◽  
Nasopharyngeal Angiofibroma ◽  
Intraoperative Bleeding ◽  
Type Iii ◽  
Type Iv ◽  
Facial Vein

We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.

scholarly journals Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

2021 ◽  
Vol 10 (17) ◽  
pp. 3926
Author(s):  
Andrea Giorgianni ◽  
Stefano Molinaro ◽  
Edoardo Agosti ◽  
Alberto Vito Terrana ◽  
Francesco Alberto Vizzari ◽  
...  
Keyword(s):  
Blood Loss ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

Hypoxia-Inducible Factor-1α (HIF-1α) Expression on Endothelial Cells in Juvenile Nasopharyngeal Angiofibroma: A Review of 70 cases and Tissue Microarray Analysis

2018 ◽  
Vol 127 (6) ◽  
pp. 357-366 ◽  
Author(s):  
Xiaole Song ◽  
Chenhe Yang ◽  
Huankang Zhang ◽  
Jingjing Wang ◽  
Xicai Sun ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Prognostic Factor ◽  
Blood Loss ◽  
Tissue Microarray ◽  
Hypoxia Inducible Factor ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma ◽  
Hypoxia Inducible Factor 1Α ◽  
Clinical Records

Objective: To examine the expression of hypoxia-inducible factor-1α (HIF-1α) and its related molecules (cellular repressor of E1A-stimulated genes [CREG], osteopontin [OPN], proto-oncogene tyrosine-protein kinase Src [c-Src], and vascular endothelial growth factor [VEGF]) in juvenile nasopharyngeal angiofibroma (JNA) and explore the correlation between clinical prognosis and HIF-1α expression. Methods: The study performed a retrospective review of the clinical records of patients with JNA treated between 2003 and 2007. Specimens were analyzed by immunohistochemistry for HIF-1α, CREG, OPN, c-Src, and VEGF expression, and microvessel density (MVD) was assessed by tissue microarray. The correlation between expression levels and clinicopathological features including age, tumor stage, intraoperative blood loss, and recurrence was analyzed. Results: HIF-1α, CREG, OPN, c-Src, and VEGF were upregulated in endothelial cells (ECs) of patients with JNA, and strong correlations in the expression of these molecules were observed. HIF-1α expression was higher in young patients ( P = .032) and in recurrent cases ( P = .01). Survival analysis showed that low HIF-1α levels in ECs predicted longer time to recurrence (log rank test P = .006). Receiver operating characteristic curve analysis showed that HIF-1α was a prognostic factor for recurrence (area under the curve = 0.690, P = .019). No correlation was found between the expression of molecules and Radkowski stage or intraoperative blood loss. Conclusion: In cases of JNA treated surgically, HIF-1α expression in ECs is a useful prognostic factor for tumor recurrence.

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

scholarly journals Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Nagase ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Takeya Hara ◽  
Aiko Okada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Multivariate Regression ◽  
Placenta Previa ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

scholarly journals Effect of premedication with oral clonidine on intraoperative blood loss during rhinoplasty surgery - A systematic review

2020 ◽  
Vol 11 (4) ◽  
pp. 5206-5213
Author(s):  
Sudarssan Subramaniam Gouthaman ◽  
Janani Kandamani ◽  
Divya Sanjeevi Ramakrishnan ◽  
P. U. Abdul Wahab
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Surgical Procedure ◽  
Intraoperative Blood Loss ◽  
Pertinent Literature ◽  
Intraoperative Bleeding ◽  
Oral Clonidine ◽  
Hypotensive Anaesthesia ◽  
The Past ◽  
Manual Search

Rhinoplasty is one frequent surgical procedure of many technical variations that only a few surgeons are considered to have mastered its broad scope. Operative site bleeding is considered to be an exasperating issue in the surgical procedure of rhinoplasty. Over the past few decades, the strategy of lowering patient's blood pressure during anaesthesia or "Hypotensive anaesthesia" has been practised to reduce the blood loss during surgeries. Clonidine is an antihypertensive drug and is suggested to have advantageous effects in controlling the intraoperative blood loss. The objective of this systematic review was to explore and study the existing literature and determine the efficacy of oral clonidine as a premedication in reducing the intraoperative blood loss in rhinoplasty surgeries. Data was gathered from electronic databases like PubMed, Medline and Cochrane central library. An additional manual search was performed with various journals to look for available articles to include in the systematic review. Only those studies which met the criteria for inclusion were selected. All studies and reports that evaluated oral clonidine with placebo in reducing bleeding during rhinoplasty surgery were included. Pertinent literature abstracts and full-text articles pertaining to the query were analysed. Two articles in total were taken in for qualitative analysis, both of which were randomised clinical trials. Oral clonidine shows significantly more efficient in reducing intraoperative bleeding than the placebo group. Premedication with oral clonidine is significantly effective in controlling blood loss during the surgical procedure of rhinoplasty.

Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma

2018 ◽  
Vol 127 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Kareem O. Tawfik ◽  
Jeffrey J. Harmon ◽  
Zoe Walters ◽  
Ravi Samy ◽  
Alessandro de Alarcon ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Facial Nerve ◽  
Blood Supply ◽  
Facial Palsy ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Potential Complication ◽  
Nasopharyngeal Angiofibroma

Objectives: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. Methods: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. Results: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Conclusions: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

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