Angiographic Analysis as an Intraoperative Predictor in Adult Patients with Juvenile Angiofibroma: A Descriptive Study

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor with an estimated incidence of 0.05–0.5% of all head and neck neoplasms. It predominantly affects adolescent males and is characterized by aggressive local growth and marked vascularity, making surgical resection challenging due to the risk of massive bleeding. Advances in diagnostic imaging and selective preoperative angiography have transformed its management by enabling detailed vascular mapping and embolization, reducing tumor vascularity and intraoperative blood loss. Nevertheless, the predictive value of angiographic findings for bleeding, operative time, and recurrence remains unclear, particularly in relation to internal carotid artery (ICA) feeders and the number of vascular contributors. Objective: To describe the demographic, radiological, angiographic, and surgical characteristics of a cohort of patients with JNA and to analyze correlations between angiographic variables, intraoperative bleeding, operative time, and recurrence. Materials and Methods: We conducted a retrospective study including all patients diagnosed with JNA and surgically treated at the “Instituto de Neurocirugía Dr. Alfonso Asenjo” between 2017 and 2024. Preoperative demographic and clinical data were collected, including age, symptom duration, and laterality. Imaging (CT/MRI) was used to classify tumors according to Radkowski’s staging system. All patients underwent preoperative angiography to document arterial supply and to guide embolization. Intraoperative variables included operative time, estimated blood loss, complications, and recurrence. Results: Nine male patients aged 10–28 years (median 15 years) were included. Tumors originated predominantly in the pterygopalatine fossa, with extension into paranasal sinuses, skull base, or intracranial compartments. All patients underwent preoperative angiography; the internal maxillary artery was the dominant feeder in 100% of cases, with additional supply from the cavernous ICA in 44% and the petrous ICA in 55%. Accessory branches (ascending pharyngeal, meningeal, or facial arteries) were present in 66%. Embolization was performed in all cases (77% particles, 11% histoacryl, 11% liquid agent). Mean operative time was 208 ± 22 minutes (range 180–252). Mean estimated blood loss was 472 ± 363 ml (range 100–1,300). The number of feeding arteries showed a moderate-to-strong correlation (ρ = 0.59; p = 0.16) with blood loss. Comparison between patients with and without cavernous ICA supply showed no significant difference in bleeding (median 500 vs 300 ml; p > 0.29). Two patients (22%) developed recurrence during follow-up at 3 and 5 years, respectively. No major perioperative complications were recorded. Conclusion: Preoperative angiography confirmed the internal maxillary artery as the main feeder in all cases, while accessory supply from ICA segments and additional branches was common. Embolization proved safe and effective in reducing intraoperative bleeding. Although no statistically significant associations were found due to the limited sample size, trends suggest that the number of feeding arteries and ICA supply may influence surgical bleeding and recurrence. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany