Materials Employed in Preoperative Embolization for Nasopharyngeal Angiofibroma: A Meta-Analysis

Characterizing outcomes and complications between preoperative embolization materials in the treatment of JNA to help guide clinical management.

PubMed, Scopus, CINAHL, Cochrane databases.

This systematic review involved a search of PubMed, Scopus, CINAHL, and Cochrane databases from inception to March 31, 2025. Meta-analysis of continuous measures (mean) and proportions (%) with a 95% confidence interval (CI) was conducted. Studies were accessed for bias via the JBI appraisal tool.

Of 2690 abstracts screened, 40 studies (N = 448) were included. Mean age was 16.1 years (range: 6-29) with 100% males. Polyvinyl Alcohol (PVA) was the most common type of embolization material (59.2%, 95% CI: 54.6-63.6), followed by cyanoacrylate glue, gelfoam, onyx, and coils. Patients treated with gelfoam were not found to have any complications, and the most intraoperative blood loss [346.7 mL (95% CI: 313.9-661.2)] was followed by coils [7.4%; 515.3 mL (95% CI: 109.2-2417.5)], PVA [13.4%; 455.6 mL (95% CI: 313.9-661.2)], Onyx [27.6%; 493.0 mL (95% CI: 334.9-725.6)], and cyanoacrylate glue [47.8%; 504.8 mL (95% CI: 322.9-789.0)], respectively. TMJ pain, trigeminocardiac reflex, and headaches were the most common embolization complications (10.6%-12.8%).

Studies have shown that embolization improves outcomes for JNA, but the choice of embolization material remains a topic of debate. This study found PVA is the most commonly utilized material and that there may be differences in outcomes and complications between embolization materials. Additional studies should be conducted to rigorously evaluate the differences.