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2018, vol. 75, br. 10, str. 1041-1044
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Okluzija centralne arterije retine posle embolizacije juvenilnog nazofaringealnog angiofibroma
Central retinal artery occlusion following embolization in juvenile nasopharyngeal angiofibroma: A case report
aKlinički centar Srbije, Klinika za očne bolesti, Beograd bKlinički centar Srbije, Klinika za očne bolesti, Beograd + Univerzitet u Beogradu, Medicinski fakultet cGeneral Hospital, Pljevlja, Montenegro
e-adresa: bkjelena@gmail.com
Sažetak
Uvod. Juvenilni nazofaringealni angiofibrom je benigna, vaskularizovana, lokalno agresivna lezija, koja se obično javlja kod adolescentnih momaka. Terapija izbora je hirurško uklanjanje. Kako ovaj tumor pokazuje sklonost ka krvarenju tokom hirurškog uklanjanja, uvođenjem preoperativne embolizacije omogućuje se operacija sa manje krvi, ali i kompletna resekcija tumora. Međutim, ova procedura nije bez komplikacija. Najozbiljnija komplikacija embolizacije jeste migracija embolusa u intrakranijalnu cirkulaciju. Prikaz bolesnika. Prikazujemo slučaj devetogodišnjeg dečaka koji je izgubio vid na levom oku posle preoperativne embolizacije juvenilnog nazofaringealnog angiofibroma zbog okluzije centralne arterije retine. Pregledom literature našli smo svega tri objavljena slučaja okluzije centralne arterije retine nakon embolizacije nazofaringealnog angiofibroma. Ovim radom želimo da ukažemo na mogućnost ove retke i teške komplikacije, kao i na značaj brze i tačne dijagnoze, jer se bolji vidni ishod dobija kod ranog započinjanja lečenja. Zaključak. Opisani slučaj okluzije centralne arterije retine je redak, jatrogeni vaskularni akcident koji može da se javi kao komplikacija embolizacije nazofaringealnih tumora. Lekari (oftalmolozi i otorinolaringolozi) bi trebalo da budu svesni ove teške komplikacije, kao i toga da je ključno detaljno praćenje angiograma radi detekcije bilo kakve vaskularne anomalije, pre i tokom embolizacije.
Abstract
Introduction. Juvenile nasopharyngeal angiofibromas are highly vascular, locally aggressive lesions, that affect male adolescents. The surgery is the treatment of choice, although it shows a strong propensity to bleed during surgical removal. Preoperative embolization enables the surgical approach in a less bloody way and also a complete resection of the tumor. However, this procedure is not without complications. The most severe complication of this technique is a migration of an embolus into the intracranial circulation. Case report. We present a 9-year-old boy who lost vison on his left eye following preoperative embolisation of juvenile nasopharyngeal angiofibromas as a result of central retinal artery occlusion. A recent review of the literature reported only three previously documented cases of central retinal artery occlusion occurring after embolization for a nasopharyngeal angiofibroma. We want to point out the possibility of this rare but devastating complication and the importance of rapid and accurate diagnosis and treatment so that a visual outcome could be better when applying an early medical treatment. Conclusion. Described case of central retinal artery occlusion is a rare and unusual, iatrogenic vascular event, that could arise as a complication from embolisation of nasopharingeal tumors. However, physicians (ophthalmologists and ear-nose-throat surgeons) should be aware of this devastating complication, and the close evaluation of angiograms for detection of any vascular abnormality before and during the embolization is crucial.
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