PMC10175024_01
Preprocedural MRI scan: coronal (a) and sagittal (b) T2-weighted views showing large JNA of right nasopharyngeal cavity with expansion of the pterygopalatine fossa and extension into the infratemporal fossa with solid and cystic component. (c) Gd-enhanced T1 gradient-echo 3D axial image showed early and strong diffuse enhancement of the lesion.
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Cranially, the lesion extended to the posterior ethmoidal region with remodeling of the floor of the anterior cranial fossa and imprinting on the optic chiasm, on the adjacent vascular structures, and on the pituitary gland and its pedicle, towards the right cavernous sinus (Figure 1).
Preoperative DSA: selective catheterization of proximal right ECA and ICA. Posteroanterior (PA) (a-c) and detailed (d) views of the JNA with major feeders from sphenopalatine branches of the distal right internal maxillary artery. Some small feeders also arise from right ICA branches (c). Controlateral ICA did not show any feeders.
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Then, a 6F guide catheter (Envoy MPC 90 cm, Cordis) in proximal ECA and superselective catheterization of lesion feeders was executed (Figure 2(a)) using a balloon-microcatheter (Fr Scepter-C, 0.0165 in, Microvention) and 0.14'' guidewire (Synchro 14, Stryker) for each side. Embolization was then performed using the Onyx 18 liquid embolic system (LES, 6%EVOH, viscosity of 18 cSt, Medtronic) in a slow infusion using blank roadmap visualization to achieve as proper distal penetration as anatomically possible until complete stasis of flow within each feeding vessel was achieved (Figure 2(b)).
(a) Intraprocedural DSA: PA view of superselective injection of distal internal maxillary artery with onyx embolization. (b, c) Postprocedural DSA: LL view of the JNA showing successful embolization of the lesion of right (b) and left (c) side. (d) Postprocedural fluoroscopy demonstrating excellent results.
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At the end of the procedure, control angiography was performed to assess the percentage of tumor feeders embolized (Figure 3). Figures 3(b)-3(d). Feeders from the ICA were not treated.
Postprocedural MRI scan performed at 1 month after surgery: coronal (a) and axial (b) T2-weighted views which show the complete resection of the JNA with empty nasal left fossa, with parietal reactive mucous thickness.
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The follow-up MRI performed 1 month after surgical treatment showed an empty nasal fossa in surgical outcomes (Figure 4).