Endoscopic embolization with onyx prior to resection of JNA: A new approach

Bjorn Herman, Michael Bublik, Jose Ruiz, Ramzi Younis

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Objective: To report a novel pioneering approach of endoscopic embolization (EE) and resection of juvenile nasopharyngeal angiofibroma (JNA) and describe all outcomes and results. Methods: Four patients presented to the University of Miami with repeated episodes of unilateral epistaxis diagnosed by fiberoptic and radiographic examination as nasal JNA. Subsequently, in conjunction with neurosurgery, endoscopic visualization was provided to perform intratumor needle insertion, through which the liquid embolic agent Onyx was infused to embolize the JNA's under fluoroscopic and endoscopic guidance. The day after EE, endoscopic resection was performed. Operating room time, estimated blood loss (EBL), and other intraoperative and post-operative results are reported and compared to published literature. Results: A total of 4 patients (all males), had EE of JNA and subsequent endoscopic resection between September 2008 and January 2009. Average EBL during surgery was 412.5. ml (range 150-800) with an average operating room time of 228. min (range 95-485). We experienced no bleeding from the tumor or its attachments, only from the approach. Two patients experienced mild numbness in the V2 distribution, which began to resolve one week post-operatively. No other complications were encountered. Conclusions: This is the first published report of direct endoscopic embolization of JNA with Onyx. Although further studies are needed, it seems to provide a safe, less invasive alternative to traditional embolization and endoscopic resection, but must be done in cooperation with interventional neurosurgery to maximize its safety profile.

Original languageEnglish (US)
Pages (from-to)53-56
Number of pages4
JournalInternational Journal of Pediatric Otorhinolaryngology
Issue number1
StatePublished - Jan 1 2011


  • Juvenile nasopharyngeal angiofibroma
  • Pediatric sinus surgery
  • Percutaneous embolization

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Pediatrics, Perinatology, and Child Health


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