Preliminary Experience with the Percutaneous Embolization of Juvenile Angiofibromas Using Only Ethylene-Vinyl Alcohol Copolymer (Onyx) for Preoperative Devascularization Prior to Surgical Resection

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Fig 1.
A 16-year-old boy who presented with epistaxis and nasal stuffiness with a Fisch grade IIIa juvenile angiofibroma. A, Coronal contrast-enhanced T1-weighted MR image shows a large contrast-enhancing mass within the right nasal cavity, extending into the right ethmoid sinus, right maxillary sinus, and right buccal space. B, Lateral right internal carotid angiogram (RICA) shows supply to the upper portion of the hypervascular mass from the inferior lateral trunk. C, Lateral right external carotid angiogram (RECA) shows the hypervascular mass with supply off the distal right internal maxillary artery, accessory meningeal artery, facial artery, and ascending pharyngeal artery. D, Lateral radiography shows the EVOH (Onyx) cast within the tumor. E, Lateral RECA postembolization shows no filling of the hypervascular mass.
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Fig 2.
A 13-year-old boy with nasal stuffiness and a Fisch Ib juvenile angiofibroma. A, Coronal contrast-enhanced T1-weighted MR image shows a contrast-enhancing mass within the left nasal cavity and posterior nasopharynx, extending into the left sphenoid sinus. B, Lateral left common carotid angiogram (LCCA) shows the hypervascular mass with supply off the ECA and ICA branches. C, Lateral DynaCT (Siemens, Erlangen, Germany) image shows the EVOH (Onyx) cast within the tumor. D, Lateral LCCA postembolization shows no filling of the hypervascular mass.

Patient characteristics

Patient	Tumor Size (AP × Trans × CC) (Maximum cm)	Amount of Onyx (mL)	No. of Needles in Tumor	Fisch/Radowski Grade	Room Time for Preop Embo (min)	Surgical Approach	Room Time for Surgery (min)	EBL (mL)	Blood Transfusion
1	6.0 × 6.1 × 4.8	23	5	IIIa/IIIA	195	Lefort I ENE	386	1700	2 U PRBC
2	6 × 5.4 × 5.3	16	2	IIIa/IIIA	279	ENE	476	1600	2 U PRBC
3	3.4 × 4.3 × 3.9	25	5	IVa/IIIB	240	ENE	503	400	None
4	3.8 × 3.3 × 4.0	16	1	IIIa/IIIA	140	ENE	381	400	None
5	6.4 × 3.2 × 3.3	22	1	IIIa/IIIA	279	ENE	488	400	None
6	2.3 × 2.1 × 1.4	2	1	I/IA	76	NE	39	10	None
7	5.9 × 5.4 × 5.0	10	1	IIIa/IIIA	125	Midface deglove/medial maxillectomy	223	200	None
8	4.3 × 2.1 × 3.3	14	2	II/IIA	157	ENE	192	200	None
9	4.5 × 4.3 × 4.9	4	2	I/IB	123	NE	267	200	None