Endoscopic approach to juvenile nasopharyngeal angiofibroma: our experience at a tertiary care centre

Abstract

Objective: To evaluate the efficacy of endoscopic exposure and excision for juvenile nasopharyngeal angiofibroma.Design: Prospective analysis of the outcomes of endoscopic removal of the angiofibroma at a tertiary care centre, using endoscopic and radiological parameters.Subjects: Twenty-eight consecutive patients with angiofibroma were included. These patients underwent endonasal endoscopic excision of the lesion, following pre-operative computed tomography and digital subtraction angiography. Post-operative endoscopy and radiology were performed at six weeks to detect any residual lesion, and thereafter at six-monthly intervals to detect recurrence.Results: Twenty-one patients (75 per cent) were new cases and seven patients (25 per cent) had recurrent tumour. Pre-operative embolisation was performed in 21 patients (75 per cent). An endoscopic endonasal approach was used to access the pterygopalatine fossa. The average blood loss was 228 ml. Residual lesion was noted in one patient (initially with recurrent stage II C pathology). The remaining 27 patients (initially with stage I, II A and II B pathology) were free of residual pathology or recurrence after a minimum follow-up period of 12 months.Conclusion: Endoscopic exposure and excision of angiofibroma was found to be effective.

Endoscopic Transnasal Anatomy of the Infratemporal Fossa and Upper Parapharyngeal Regions: Correlations with Traditional Perspectives and Surgical Implications

“…In this respect trigeminal schwannomas and juvenile angiofi bromas should be considered good candidates for these approaches. Preliminary clinical reports [9,10] and also our experience confi rm this possibility. When dealing with malignant neoplasms involving the ITF or the upper parapharyngeal region a wide resection is mandatory, and the choice to treat these kind of patients surgically must be well evaluated.…”

Nasal juvenile angiofibroma: Current perspectives with emphasis on management

“…When compared with open resection, they result in significantly less intraoperative blood loss . They do not preclude surgical cure and may allow access to deep structures not fully visualized during open surgery . En bloc resection is not necessary to achieve surgical cure and, by contrast, piecemeal resection can facilitate the approach to difficult anatomic areas.…”

“…Initially, endoscopic approaches were used for the management of small (Radkowski stages I and II) tumors . The increase of endoscopic surgical skills together with advances in surgical instrumentation, imaging, and surgical navigation systems enabled, however, the indication of these approaches even for Radkowski stages IIIA and B or University of Pittsburgh Medical Center (UPMC) stages IV and V …”

Central retinal artery occlusion following embolization in juvenile nasopharyngeal angiofibroma: A case report

“…There are some authors who found the preoperative embolisation as a risk factor, with a higher rate of JNA recurrence 13,14 . Petruson et al 13 found that the recurrence rate in non-embolized patients was 8% and 41% among embolized patients.…”