The Effectiveness of Endoscopic Surgery of Juvenile Angiofibroma Using Surgical Glue

  • Seyed-Hadyi Samimi Ardesan Department of Otorhinolaryngology, School of Medicine, Tehran University of Medical Sciences, Amiralam Hospital, Tehran, Iran
  • Mojtaba Mohammadi Ardehali Department of Otorhinolaryngology, School of Medicine, Tehran University of Medical Sciences, Amiralam Hospital, Tehran, Iran
  • Najmeh Doustmohammadian Department of Otorhinolaryngology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
Keywords: Juvenile nasopharyngeal angiofibroma, Embolization, Glubran, Blood loss


AIM: The current study aimed to provide a method for juvenile nasopharyngeal angiofibroma embolization using Glubran glue in patients with low stage tumor. This method not only has less blood loss and good visualization but also impose a low cost, where no pre-operative embolization complications were found for this procedure.

METHODS: Between 2012 and 2014, 30 patients with angiofibroma undergoing endoscopic surgery. Age, sex, tumor stage, average blood loss, complications, length of hospitalization, and recurrence rate of the tumor were the main measured outcomes. Furthermore, 30 patients were divided into three groups with matched age, sex, and tumor staging. Group 1 received glue (Glubran), while Group 2 selected for study without glue and embolization and pre-operative embolization was considered for Group 3.

RESULTS: Based on the amount bleeding, the mean blood hemorrhage in Groups 1, 2, and 3 was 510, 1655, and 800 ml, respectively, the difference of hemorrhage between Groups 1 and 2 was found to be statistically significant (p = 0.007). Blood loss in Group 1 was found to be less than Group 3, but the difference of hemorrhage between Group 1 and 3 was not statistically significant (p = 0.678). No blood transfusion and complication were recorded for individuals in Group 1. The recurrence was found in 1 patient (10%) in both groups of 2 and 3, and no patient (0%) in Group 1.

CONCLUSIONS: The direct intraoperative embolization technique with glue was capable of providing a more complete and targeted embolization of the tumor. Some advantages can be mentioned for this technique, including decreased blood loss, less radiation exposure, lower rates of complications, and recurrence, as well as shorter hospitalization time, the ease of procedure with a spinal needle and low cost.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Bakshi SS, Bhattacharjee S. Juvenile nasopharyngeal angiofibroma. J Pediatr Hematol Oncol. 2016;38(6):491-2. PMid:27164528

Erdur ZB, Yener HM, Yilmaz M, Karaaltin AB, Inan HC, Alaskarov E, et al. Cellular Angiofibroma of the Nasopharynx. J Craniofac Surg. 2017;28(8):e720-e722. https://doi. org/10.1097/scs.0000000000003845 PMid:28885437

Capodiferro S, Favia G, Lacaita MG, Lo Muzio L, Maiorano E, et al. Juvenile angiofibroma: Report of a case with primary intra-oral presentation. Oral Oncol Extra. 2005;41:1-6. https://doi. org/10.1016/j.ooe.2004.09.001

Handa KK, Kumar A, Singh MK, Chhabra AH. Extranasopharyngeal angiofibroma arising from the nasal septum. Int J Pediatr Otorhinolaryngol. 2001;58(2):163-6. PMid:11278025

Salimov A, Ozer S. A rare location of angiofibroma in the inferior turbinate in young woman. Int Arch Otorhinolaryngol. 2015;19(2):187-90. PMid:25992179

Tan L, Loh T. Benign and malignant tumors of the nasopharynx. In: Flint PW, Haughey BH, Lund VJ,Niparko JK, Robbins KT, Thomas JR, Lesperance MM, editors. Cummings Otolaryngology Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier, Sauders; 2015. p. 1420-31. b978-0-323-05283-2.00100-2

Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo- Trojanowska M. Invasive growth patterns of juvenile nasopharyngeal angiofibroma: Radiological imaging and clinical implications. Acta Radiol. 2014;55(6):725-31. https://doi. org/10.1177/0284185113506189 PMid:24132768

McKnight CD, Parmar HA, Watcharotone K, Mukherji SK. Reassessing the anatomic origin of the juvenile nasopharyngeal angiofibroma. J Comput Assist Tomogr. 2017;41(4):559-64. PMid:28632604

Alshaikh NA, Eleftheriadou A. Juvenile nasopharyngeal angiofibroma staging: An overview. Ear Nose Throat J. 2015;94(6):E12-22. https://doi. org/10.1177/014556131509400615 PMid:26053985

Tan G, Ma Z, Long W, Liu L, Zhang B, Chen W, et al. Efficacy of preoperative transcatheter arterial embolization for nasopharyngeal angiofibroma: A comparative study. Cardiovasc Intervent Radiol. 2017;40(6):836-44. s00270-017-1587-3 PMid:28175976

López F, Triantafyllou A, Snyderman CH, Hunt JL, Suárez C, Lund VJ, et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck. 2017;39(5):1033- 45. PMid:28199045

Maroldi R, Nicolai P. Imaging in Treatment Planning for Sinonasal Diseases. New York, USA: Springer; 2004.

Lloyd G, Howard D, Lund VJ, Savy L. Imaging for juvenile angiofibroma. J Laryngol Otol. 2000;114(9):727-30. https://doi. org/10.1258/0022215001906642 PMid:11091844

Lund VJ, Stammberger H, Nicolai P, Castelnuovo P, Beal T, Beham A, et al. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl. 2010;22:1-43. PMid:20502772

Wu AW, Mowry SE, Vinuela F, Abemayor E, Wang MB. Bilateral vascular supply in juvenile nasopharyngeal angiofibromas. Laryngoscope. 2011;121(3):639-43. lary.21337 PMid:21344446

Enepekides DJ. Recent advances in the treatment of juvenile angiofibroma. Arch Otolaryngol Head Neck Surg. 2004;12:495-9.

Mcafee WJ, Morris CG, Andur RJ, Werning JW, Mendenhall WM. Definitive radiotherapy for juvenile nasopharyngeal angiofibroma. Am J Clin Oncol. 2006;29:168-70.

Ye D, Shen Z, Wang G, Deng H, Qiu S, Zhang Y. Analysis of factors in successful nasal endoscopic resection of nasopharyngeal angiofibroma. Acta Otolaryngol. 2016;136(2):205-13. https:// PMid:26492972

Ferreira LM, Gomes EF, Azevedo JF, Souza J.R., Araújo RP, Rios AS. Endoscopic surgery of nasopharyngeal angiofibroma. Rev Bras Otorrinolaringol. 2006;72:475-80.

Andrade NA, Pinto JA, Nóbrega MO, Aguiar JE, Aguiar TF, Vinhaes ES. Exclusively endoscopic surgery for juvenile nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg. 2007;137(3):492-6. otohns.2007.03.003 PMid:17765782

Sirakov S, Sirakov A. Preoperative endovascular embolization of juvenile nasopharyngeal angiofibroma. Int J Sci Res. 2017;6:1434-6.

Borghei P, Baradaranfar MH, Borghei SH, Sokhandon F. Transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma without preoperative embolization. Ear Nose Throat J. 2006;85(11):740-3, 746. https://doi. org/10.1177/014556130608501114 PMid:17168151.

Garça MF, Yuca SA, Yuca K. Juvenile nasopharyngeal angiofibroma. Eur J Gen Med. 2010;7:419-425. https://doi. org/10.29333/ejgm/82897

Zähringer M, Guntinas-Lichius O, Gossmann A, Wustrow J, Krüger K, Lackner K. Percutaneous embolization for cervicofacial neoplasms and hemorrhages. ORL J Otorhinolaryngol Relat Spec. 2005;67(6):348-60.


Hackman T, Snyderman CH, Carrau R, Vescan A, Kassam A. Juvenile nasopharyngeal angiofibroma: The expanded endonasal approach. Am J Rhinol Allergy. 2009;23(1):95-9. PMid:19379621

Tranbahuy P, Borsik M, Herman P, Wassef M, Casasco A. Direct intratumoral embolization of juvenile angiofibroma. Am J Otolaryngol. 1994;15(6):429-35. https://doi. org/10.1016/0196-0709(94)90084-1 PMid:7872479

Lehmann M, Ulrich S, Reineke U, Hamberger U, Dietrich U, Sudhoff H. Intratumoral Onyx embolisation in the management of juvenile nasopharyngeal angiofibroma. HNO. 2010;58(8):853-7. PMid:20596683

Herman B, Bublik M, Ruiz J, Younis R. Endoscopic embolization with onyx prior to resection of JNA: A new approach. Int J Pediatr Otorhinolaryngol. 2011;75(1):53-6. ijporl.2010.10.006 PMid:21051094

Raissi D, Yu Q, Mardini SH. Upper gastrointestinal bleed embolization with onyx®: The “tattoo effectâ€. J Clin Imaging Sci. 2018;8:46. PMid:30546930

Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, et al. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J. 2009;18(8):1169-74. PMid:19283413

Vaiman M, Sarfaty S, Eviatar E. The use of fibrin sealant as a glue for septoplasty and conchotomy. Rhinology. 2009;47(3):297- 300. PMid:19839254

Elhammady MS, Johnson JN, Peterson EC, Aziz-Sultan MA. Preoperative embolization of juvenile nasopharyngeal angiofibromas: Transarterial versus direct tumoral puncture. World Neurosurg. 2011;76(3-4):328-34. https://doi. org/10.1016/j.wneu.2010.11.011 PMid:21986432

Gemmete JJ, Patel S, Pandey AS, Sullivan SE, McKean EL, Marentette LJ, et al. Preliminary experience with the percutaneous embolization of juvenile angiofibromas using only ethylene-vinyl alcohol copolymer (Onyx) for preoperative devascularization prior to surgical resection. AJNR Am J Neuroradiol. 2012;33(9):1669- 75. PMid:22499846

Probst EN, Grzyska U, Westphal M, Zeumer H. Preoperative embolization of intracranial meningiomas with a fibrin glue preparation. AJNR Am J Neuroradiol. 1999;20(9):1695-702. PMid:10543643

Shaffrey CI, Spotnitz WD, Shaffrey ME, Jane JA. Neurosurgical applications of fibrin glue: Augmentation of dural closure in 134 patients. Neurosurgery. 1990;26(2):207-10. https://doi. org/10.1227/00006123-199002000-00004 PMid:2308667

Danesi G, Panizza B, Mazzoni A, Calabrese V. Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension. Otolaryngol Head Neck Surg. 2000;122(2):277-83. PMid:10652407

Herman P, Lot G, Chapot R, Salvan D, Huy PT. Long-term follow-up of juvenile nasopharyngeal angiofibromas: Analysis of recurrences. Laryngoscope. 1999;109(1):140-7. https://doi. org/10.1097/00005537-199901000-00027 PMid:9917056

Gullane PJ, Davidson J, O’Dwyer T, Forte V. Juvenile angiofibroma: A review of the literature and a case series report. Laryngoscope. 1992;102(8):928-33. https://doi. org/10.1288/00005537-199208000-00014 PMid:1323003

Jorissen M, Eloy P, Rombaux P, Bachert C, Daele J. Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma. Acta Otorhinolaryngol Belg. 2000;54(2):201-19. PMid:10892510

Howard DJ, Lloyd G, Lund V. Recurrence and its avoidance in juvenile angiofibroma. Laryngoscope. 2001;111(9):1509-11. PMid:11568597

Sun XC, Wang DH, Yu HP, Wang F, Wang W, Jiang JJ. Analysis of risk factors associated with recurrence of nasopharyngeal angiofibroma. J Otolaryngol Head Neck Surg. 2010;39(1):56-61. PMid:20122346

Quinn FB, Ryan MW, Ulualp S. Juvenile Nasopharyngeal Angiofibroma: Grand Rounds Presentation. USA: UTMB Department of Otolaryngology Head and Neck Surgery; 2007.

How to Cite
Ardesan S-HS, Ardehali MM, Doustmohammadian N. The Effectiveness of Endoscopic Surgery of Juvenile Angiofibroma Using Surgical Glue. Open Access Maced J Med Sci [Internet]. 2020Mar.24 [cited 2020Oct.31];8(B):150-4. Available from: