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      Geometric alopecia after preoperative angioembolization of juvenile nasopharyngeal angiofibroma

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          Abstract

          Resection of a juvenile nasopharyngeal angiofibroma (JNA) is challenging because of high intraoperative blood loss secondary to the tumor's well-developed vascularity. Endoscopic sinus and skull base surgeons commonly collaborate with neurointerventionalists to embolize these tumors before resection in an attempt to reduce the vascular supply and intraoperative bleeding. However, angioembolization can be associated with significant complications. Geometric alopecia from angioembolization of JNA has not been previously reported in the otolaryngologic literature. In this study, we discuss geometric alopecia from radiation exposure during preoperative angioembolization of a JNA.

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          Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair.

          Most advice currently available with regard to fluoroscopic skin reactions is based on a table published in 1994. Many caveats in that report were not included in later reproductions, and subsequent research has yielded additional insights. This review is a consensus report of current scientific data. Expected skin reactions for an average patient are presented in tabular form as a function of peak skin dose and time after irradiation. The text and table indicate the variability of reactions in different patients. Images of injuries to skin and underlying tissues in patients and animals are provided and are categorized according to the National Cancer Institute skin toxicity scale, offering a basis for describing cutaneous radiation reactions in interventional fluoroscopy and quantifying their clinical severity. For a single procedure performed in most individuals, noticeable skin changes are observed approximately 1 month after a peak skin dose exceeding several grays. The degree of injury to skin and subcutaneous tissue increases with dose. Specialized wound care may be needed when irradiation exceeds 10 Gy. Residual effects from radiation therapy and from previous procedures influence the response of skin and subcutaneous tissues to subsequent procedures. Skin irradiated to a dose higher than 3-5 Gy often looks normal but reacts abnormally when irradiation is repeated. If the same area of skin is likely to be exposed to levels higher than a few grays, the effects of previous irradiation should be included when estimating the expected tissue reaction from the additional procedure. (c) RSNA, 2010.
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            Radiation-induced temporary alopecia after embolization of cerebral arteriovenous malformations.

            Alopecia after endovascular embolization of cerebral arteriovenous malformations (AVMs) is uncommon. In this report, we present a 33-year-old man who developed temporary alopecia after staged embolization of a cerebral AVM. Four days after the last procedure, this patient had hair loss over his right temporoparietal and occipial areas. No scalp erythema or other sign of dermatitis was noted. The hair regrew 2 months later. The alopecia was considered to be related to repeated exposure to radiation during embolization. The experience in this case and review of the literature suggest that interventional neuroradiological procedures may cause substantial radiation exposure to the patient. Therefore, radiation use should be limited to the least amount necessary to complete the endovascular procedure to prevent radiation-induced biological changes and morbidity. Patients should be well informed of adverse effects such as alopecia.
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              Radiation-induced temporary epilation after a neuroradiologically guided embolization procedure.

              A 34-year-old woman underwent embolization of a left paraorbital arteriovenous malformation guided with a bi-plane x-ray system in two sessions separated by 3 days. Imaging included 110 minutes of fluoroscopy and 46 digital subtraction angiography acquisitions. Entrance skin dose rates were determined with measurements performed on a skull phantom. The maximum possible skin dose was estimated to be 6.6 Gy, which is consistent with the temporary epilation in the right occipital region of the skull reported by the patient approximately 5 weeks later.
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                Author and article information

                Journal
                Allergy Rhinol (Providence)
                Allergy Rhinol (Providence)
                ar
                Allergy & Rhinology
                OceanSide Publications, Inc. (Providence, RIUSA )
                2152-6575
                2152-6567
                Spring 2013
                14 May 2013
                : 4
                : 1
                : e21-e24
                Affiliations
                [1]From the Departments of 1Otolaryngology–Head and Neck Surgery and
                [2] 2Neurological Surgery,
                [3] 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey
                Author notes
                Address correspondence and reprint requests to Jean Anderson Eloy, M.D., F.A.C.S., Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103 E-mail address: jean.anderson.eloy@ 123456gmail.com
                Article
                AR048-12
                10.2500/ar.2013.4.0048
                3679562
                23772321
                40db339e-0c47-4a68-835d-e734bf5ed3da
                Copyright © 2013, OceanSide Publications, Inc., U.S.A.

                This publication is provided under the terms of the Creative Commons Public License ("CCPL" or "License"), in attribution 3.0 unported (Attribution Non-Commercial No Derivatives (CC BY-NC-ND)), further described at: http://creativecommons.org/licenses/by-nc-nd/3.0/legalcode. The work is protected by copyright and/or other applicable law. Any use of the work other then as authorized under this license or copyright law is prohibited.

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                Categories
                Articles

                Immunology
                alopecia,angioembolization,endoscopic endonasal approach,endoscopic skull base surgery,geometric alopecia,jna,juvenile nasopharyngeal angiofibroma,pediatric sinonasal tumor,skull base,skull base tumor

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