2026 Poster Presentations
P478: IMPACT OF TUMOR VASCULARITY AND EXTENT OF EMBOLIZATION ON SURGICAL OUTCOMES IN JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
Nader G Zalaquett, MD1; Brennan G Olson, MD, PhD1; Hafsa Aden1; Janalee K Stokken, MD1; Joshua P Wiedermann, MD1; Eric J Moore, MD1; Erin K O'Brien, MD1; Jacob G Eide, MD1; Jamie J Van Gompel, MD1; Waleed Brinjikji, MD1; Harry Cloft, MD, PhD1; Carlos Pinheiro-Neto, MD, PhD2; 1Mayo Clinic; 2New York University
Background: Preoperative vascular embolization (PVE) is widely used to decrease blood loss and facilitate resection in juvenile nasopharyngeal angiofibroma (JNA). Whether vascularization patterns and extent of embolization relate to surgical outcomes and prognosis remains unclear.
Methods: We conducted a 15-year, single-institution retrospective review of patients with JNA who underwent resection (2010–2025). Demographics, radiographic and pathologic tumor volumes, University of Pittsburgh Medical Center (UPMC) stage, vascular supply, number of vessels embolized, and post-embolization blush were recorded. Post-embolization blush was calculated as the area of the residual blush post-embolization compared to the total area of tumor blush pre-embolization. Outcomes included operative time, intraoperative blood loss, transfusion requirement, residual disease, complications, length of stay, recurrence, and time to recurrence. Comparative analyses were performed by number of vessels embolized (≤2 vs ≥3), ICA contribution (yes/no), and presence of post-embolization blush (yes/no).
Results: Forty-four patients underwent surgery; 43 received PVE. Most embolizations were transarterial (93.0%), commonly using polyvinyl alcohol–based agents (79.1%). The internal maxillary artery was embolized in 93.0% of cases. ICA contribution was present in 34.9%. Post-embolization tumor blush occurred in 60.5% with a median residual blush of 5% (IQR 5–10%) of the pre-embolization blush. Vascular complexity correlated with angiographic features: patients with ≥3 embolized vessels were more likely to have ICA contribution (46.7% vs 10.7%, p=0.009), and those with ICA contribution more often had residual blush (86.7% vs 46.4%, p=0.020) with higher post-embolization blush percentages (median 5.0% vs 0.0%, p=0.033). Importantly, across comparisons by number of vessels, ICA contribution, and post-embolization blush, there were no significant differences in operative time, surgical approach, intraoperative blood loss, transfusion, residual disease, complications, or recurrence. Thus, increased vascularity and more extensive embolization were not associated with adverse perioperative or long-term surgical outcomes.
Conclusions: In this single-institution experience, effective preoperative embolization yields favorable and comparable surgical outcomes in JNA irrespective of vascular complexity, ICA contribution, or post-embolization blush. These findings support routine PVE and suggest that the adequacy and quality of embolization, rather than complete angiographic devascularization or number of feeders, are the principal determinants of perioperative results and prognosis.