<div>Letter to the Editor</div><div>Coil Navigation – Imaging for Juvenile nasopharyngeal Angiofibroma</div><div>Abstract</div><div>Juvenile nasal angiofibroma is a benign tumour mainly found in
adolescent males. Its primary treatment is surgical excision.
Preoperative embolisation is widely peformed prior to the surgery. We
propose some changes to the approach to the pre-operative navigation
imaging that may help improve the resection.</div><div>Dear Editor,</div><div>Juvenile nasopharyngeal angiofibroma (JNA) is a locally aggressive
tumour which accounts for about 0.05% of all head and neck tumours. It
is the most common tumour presenting in the nose and nasopharynx and is
almost exclusively seen in young adolesent men. The most common site of
JNA is the sphenopalatine foramen and it extends from here into the
pterygopalatine fossa, infratemporal fossa, nasal cavity , paranasal
sinuses, cavernous sinus, intracranial cavity, infraorbital fissure and
orbit, paraphayrngeal space and neck. Routine preoperative imaging
includes computed tomography (CT) and magnetic resonance imaging (MRI),
which help in confirming the diagnosis and extent of the disease. CT,
MRI, and angiography assist in defining the location, the relationship
to important neurovascular structures, and assessment of the blood
supply which facilitate surgical planning.(1)</div><div>Since the evolution of surgical navigation technology, the ease of
surgical resection has greatly improved. CT is considered superior in
outlining bony landmarks, invasion to neighbouring structures and
demonstrating any bony erosion. Bilateral Carotid angiography is
essential to recognise the blood supply of the JNA. Pre-operative
embolisation is widely performed prior to surgery, however some surgeons
hold the view that embolisation can give the impression of shrinkage of
the tumour, leading to incomplete resection (2,3).</div><div>We propose some changes to the approach to pre-operative navigation
imaging that may help improve resection rates. For the past nine years
we have been undertkaing navigation protocol CT imaging immeditately
after embolisation (Figure ).</div><div>The overall benefit of these post embolisation scans is the accurate
identification of the extent of the tumour post embolisation,
highlighting important landmarks to the operating surgeon, allowing the
surgeon to use intraoperative surgical navigation to reach the
embolisaiton coils and the main feeding arteries to the tumour and
ultimatley achieving more radical resections.</div>