Juvenile Nasopharyngeal Angiofibroma: Review of Imaging Findings and Endovascular Preoperative Embolization Strategies

Neuroradiologists play a crucial role in the multidisciplinary evaluation and treatment of patients with juvenile nasopharyngeal angiofibroma. CT and MR imaging allow a relatively specific noninvasive diagnosis, assuming primary importance in staging these lesions for treatment planning. Diagnostic conventional angiography defines vascular supply and potential routes of preoperative embolization, an intervention shown to significantly reduce intraoperative bleeding during surgical resection. Our purpose is to discuss pertinent cross-sectional and neurovascular anatomy, review characteristic imaging findings in patients with juvenile nasopharyngeal angiofibroma, and illustrate various endovascular approaches to preoperative embolization. Case examples are used to highlight characteristic noninvasive and invasive diagnostic imaging findings and important considerations pertinent to appropriate preoperative embolization.

Learning Objectives: Describe characteristic non-invasive imaging findings on CT and MRI; understand the anatomy of the pterygopalatine fossa and potential pathways of tumor extension; describe the commonly used Radkowski staging scheme for JNA; and describe indications for, pitfalls of, and techniques of pre-operative embolization of JNA.