Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature

Abstract

Objectives:

Systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature in order to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications.

Methods:

Literature was searched by 2 reviewers in online databases including PubMed and Embase with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. Reference sections of identified studies were examined for additional articles. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models.

Results:

Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (Min = 20 mL; Max = 1482 mL). It was 414.6 mL (Min = 20 mL; Max = 1000 mL) and 774.2 mL (Min = 228 mL; Max = 1482 mL) respectively in the group with and without embolization. No conclusion could be taken because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval, 0.083-0.117). It was 9.3% (95% confidence interval, 0.072-0.115) for complications and 7.7% (95% confidence interval, 0.054-0.101) for residual tumor.

Conclusions:

Endoscopic treatment is an evolving modality. It is considered today as the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.