TY - JOUR T1 - Preliminary Experience with the Percutaneous Embolization of Juvenile Angiofibromas Using Only Ethylene-Vinyl Alcohol Copolymer (Onyx) for Preoperative Devascularization Prior to Surgical Resection JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1669 LP - 1675 DO - 10.3174/ajnr.A3043 VL - 33 IS - 9 AU - J.J. Gemmete AU - S. Patel AU - A.S. Pandey AU - S.E. Sullivan AU - E.L. McKean AU - L.J. Marentette AU - N. Chaudhary Y1 - 2012/10/01 UR - http://www.ajnr.org/content/33/9/1669.abstract N2 - BACKGROUND AND PURPOSE: Juvenile angiofibromas are hypervascular tumors that may benefit from preoperative devascularization to reduce intraoperative blood loss. Our purpose was to evaluate the extent of angiographic devascularization and intraoperative blood loss by using only Onyx for percutaneous juvenile angiofibroma tumor embolization. MATERIALS AND METHODS: We reviewed the clinical records and preoperative and postoperative imaging studies of a consecutive series of 9 patients with juvenile angiofibromas who were treated with preoperative embolization with direct percutaneous injection of Onyx followed by resection from a standard open surgical or endoscopic approach. RESULTS: Two Fisch type I, 1 Fisch type II, 5 Fisch type IIIa, and 1 Fisch type IVa tumor were treated. Complete devascularization was achieved in all cases percutaneously with only Onyx. There were no complications. The average intraoperative blood loss was 567.7 mL (range, 10–1700 mL). An average of 2.2 needles (range, 1–5 needles) was placed into the tumor. An average of 14.6 mL of Onyx (range, 2–25 mL) was injected into each tumor. Four Fisch type IIIa tumors were removed completely from only an ENE approach. CONCLUSIONS: Presurgical direct percutaneous embolization of a juvenile angiofibroma with only EVOH before surgical resection is safe and feasible. Our preliminary experience suggests that Onyx may offer a higher degree of devascularization compared with other embolic agents. This may facilitate an easier surgical resection with lower blood loss. EBLestimated blood lossECAexternal carotid arteryENEexpanded nasal endoscopic approachEVOHethylene-vinyl alcohol copolymerPRBCpacked red blood cells ER -