Direct Intranasal Intratumoral Embolization of Onyx before Endoscopic Endonasal Resection of a Massive Juvenile Angiofibroma for a Patient with von Willebrand's Disease: A Case Report and Review of Literature
Bibliographic record
Abstract
Background: The standard treatment of a juvenile angiofibroma (JNA) is surgical resection, usually with an endoscopic endonasal surgery, which can be technically difficult, depending on the localization and the size of the tumor. Preoperative embolization has now conceivably become a standard of practice. However, it is sometimes difficult to completely devascularize tumors with standard intra-arterial embolization. A novel technique of direct intranasal intratumoral embolization of onyx has been described and has now been used by multiple institutions around the world. Objectives: To present a case in which intranasal intratumoral embolization of onyx allowed safe and complete surgical resection of a complex case of JNA. To review existing literature on this embolization technic. Case Presentation: A 12-year-old patient suffering from von Willebrand's disease presented with a voluminous JNA with intracranial and intraorbital extension. Approximately 15% of its vascularization came from internal carotid branches. The patient had two previous incomplete surgical resections because of massive perioperative bleeding. Both surgeries had been preceded by a standard intra-arterial preoperative embolization that failed to completely devascularize the tumor. Results: A direct intratumoral embolization of onyx allowed safe and complete devascularization of the tumor, including the arterial blood flow coming from the internal carotid branches. Complete resection of the tumor was then achieved by endonasal endoscopic surgery. No complication occurred after the embolization, as well as postoperatively. This embolization technique allowed surgeons to safely dissect the entire tumor. Blood loss was minimized and surgical time was drastically decreased. Conclusion: This novel embolization technique allowed surgeons to complete the resection of a massive JNA, for a patient suffering from von Willebrand's disease, without any complication. This embolization technique allowed for a complete devascularization of the arterial blood flow of the tumor. It corroborates the fact that this technique is safe, effective, and may allow surgeons to complete the resection of bigger and more complex tumors. We strongly suggest that the technique should be done with an experienced team. Publication History Article published online: 01 February 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".