Angiographic Findings in 16 Patients with Juvenile Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma is a benign, highly vascular, fibrous tumor originating in the nasopharynx of young boys and reputed to undergo spontaneous regression at puberty (5). Angiography has shown clearly that these tumors penetrate through normal fissures and foramina to extend into the regions adjacent to the nasopharynx. The angiographic appearance is characteristic enough for a histological diagnosis. Angiography is also valuable in planning a surgical attack and in evaluating the therapeutic results (6). Material Over a period of approximately two years, 18 patients were studied by extensive angiography, and later the radiographic findings were verified by surgical excision. The ages at which these patients first sought medical attention ranged from seven to twenty years, but the thirteen- to sixteen-year-old group was predominant. Two of the 18 were females, but their clinical course and angiographic appearance are sufficiently different to exclude juvenile nasopharyngeal angiofibroma, although at one time pathological reports suggested this diagnosis in both. Their final diagnoses were hemangioendothelioma and hypertrophic adenoid tissue. Technic The radiographic studies included routine views of the paranasal sinuses, and in selected instances laminagraphy was added for greater anatomical detail. The angiographic investigations in all cases consisted of a minimum of bilateral selective internal and external carotid angiograms. Most of the patients also underwent bilateral selective vertebral angiography. In some instances, thyro-cervical trunk angiography was performed to visualize collateral flow patterns. The studies were carried out primarily via the transfemoral route, using a radiopaque polyethylene catheter with a preformed curved tip. This catheter could be maneuvered from the aortic arch to preform selective internal as well as external carotid angiography. Following satisfactory completion of that portion of the study, the catheter could be maneuvered into the vertebral arteries and thyrocervical trunks. Simultaneous injection of the external carotid arteries for anteroposterior and basal projections was occasionally useful to compare the course of the two external carotid arteries, as well as to produce better opacification of the tumor. Under these circumstances, a second catheter was introduced into the opposite common carotid artery via a percutaneous Seldinger technic, using a smaller radiopaque polyethylene catheter, The smaller catheter is approximately 22 cm long and can be maneuvered selectively into the internal and external carotid arteries under horizontal image-amplification fluoroscopy. The catheter tip should remain in the proximal external carotid artery in order to insure good opacification of the ascending pharyngeal artery, an important part of the blood supply to these tumors.