Figure 6(A-F).

Transarterial and percutaneous embolization of recurrent juvenile nasopharyngeal angiofibroma (JNA). A 16-year-old boy with recurrent JNA was planned for preoperative embolization. (A) Preembolization right ECA angiogram shows intense tumor blush (black arrow) predominantly supplied by the internal maxillary artery (B) Postembolization ECA angiogram shows no tumor blush. (C) ICA angiogram after embolization of the external carotid artery feeders shows extensive tumor blush (arrow) supplied by cavernous and ophthalmic branches of ICA. (D) The tumor territory supplied by ICA was devascularized by direct puncture (arrow head) and glue embolization. Note the coils (dotted arrows) placed in multiple feeding arteries of ECA after embolizing the tumor bed using PVA. (E) Radiograph shows glue cast (white arrow) conforming to the tumor blush supplied by ICA feeders. (F) Postembolization ICA angiogram shows marked reduction in tumor blush with minimal residue (dotted arrow). Estimated blood loss during surgery was less than 500 cc and did not receive blood transfusion