Endoscopic Surgery for Juvenile Nasopharyngeal Angiofibroma

Abstract

Objective: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. External or intraoral incisions are standard open approaches, now endonasal endoscope surgery is widely accepted for its low invasion and high success rate. The purpose of this article is to present our experience with 16 patients diagnosed with JNA who were resected with endonasal endoscope surgery.

Method: Records of 16 patients aged 11 to 32 with a mean age of 19.5 years treated by endoscopic surgery in our department between 2003 and 2010 were reviewed retrospectively. All patients were male. Preoperative radiological evaluation included both high resolution computed tomography with 1-mm cuts, and magnetic resonance imaging (MRI). According to Radkowski’s classification, 4 patients were stage Ia, 5 patients were stage Ib, 4 patients were stage IIa, and 3 patients were stage IIb. The tumor stages, feeding vessels, operating time, complications, and recurrence were observed and recorded. Eight patients received preoperative angiographic embolization, and 3 patients received intraoperative external carotid artery clamping. Transnasal or transpterygoid and posterolateral wall of maxillary sinus approaches are used for tumor resection.

Results: The mean duration of the surgery was 2 hours. The mean intraoperative blood loss of patients who received preoperative hyperselective embolization was 470 mL, patients who received intraoperative external carotid artery clamping was 510 mL, and patients who did not receive arterial supply blocking was 930 mL. After surgery, CT scan or MR image showed total removal of the tumor was achieved in all patients. No postoperative complications were observed. All patients were followed-up for 9 months to 3 years (mean 1.5 years), and no recurrence was founded.

Conclusion: Endoscopic resection of JNA is a difficult but effective operation. The key techniques to remove tumor are bleeding control, drilling-out the bone that the tumor invaded. Endonasal surgery combined with a preoperative embolization of the arterial supply can control blood loss. For small and intermediate-sized JNA (Radkowski Ia-IIb), endoscopic surgery is an appropriate choice. If the tumor extends into lateral fossa infratemporalis or deep into the skull base,we do not recommend it.