Management of persistent juvenile angiofibroma after endoscopic resection: Analysis of a single institution series of 74 patients

Abstract

Background Management of persistent juvenile angiofibroma (pJA) after transnasal endoscopic resection is controversial. To better understand its behavior, optimize treatment, and minimize morbidity, we report our experience in pJA focusing on follow‐up strategies and disease progression. Methods A retrospective review of clinical records of all JA cases treated with endoscopic surgery at the Unit of Otorhinolaryngology of the University of Brescia between January 1994 and October 2015 was performed. Results Seventy‐four cases were included. Mean follow‐up was 113 months (6‐266 months). Evolution of pJA was analyzed in 6 cases. Residual lesion size significantly decreased in 3 cases and 2 lesions did not show size variations; significant growth was detected in 1 case of intentional pJA, with diameter increasing by 2.2 mm/yr. Conclusions pJAs may have the tendency to regress spontaneously or remain stable. In selected cases, avoiding treatment of nongrowing pJA in critical areas is a prudent option.

Early Postoperative Magnetic Resonance in the Diagnosis of Persistent Juvenile Angiofibroma

“…Transarterial embolization with polyvinyl alcohol particles and endoscopic resection of JA were performed following the general principles described in previous publications. 9,12,15,22,23 Postoperative MRI (hereby defined "early postoperative MRI") for detection of unintentional pJA was scheduled prior to discharge, according to availability of the Unit of Radiology; presence of nasal packing did not contraindicate MRI acquisition. All MRI studies were performed with a 1.5 Tesla scanner (Siemens Magnetom Aera, Siemens Healthcare, Erlangen, Germany).…”

“…[1][2][3][4][5][6][7][8] Transnasal endoscopic resection following embolization is the mainstay of treatment in the large majority of JAs. 1,[9][10][11][12] However, despite continuous refinements in surgical technique, an unintentional persistence of JA (pJA) is present during postoperative surveillance in up to 7% of cases. 12,13 The prevalent current opinion is that all post-surgical recurrent lesions are actually persistent disease resulting from incomplete excision, and not de novo disease.…”

“…1,[9][10][11][12] However, despite continuous refinements in surgical technique, an unintentional persistence of JA (pJA) is present during postoperative surveillance in up to 7% of cases. 12,13 The prevalent current opinion is that all post-surgical recurrent lesions are actually persistent disease resulting from incomplete excision, and not de novo disease. [13][14][15] Although pJA can be theoretically left in many locations, the pterygoid root is the most frequently involved site due to the well-known propensity of JA to grow in the cancellous bone of the sphenoid.…”

“…Moreover, thanks to 3D, T1-weighted, fat saturated, contrast-enhanced sequences with high spatial resolution, MRI is more efficient even in depicting permeation into the medullary bone than contrast-enhanced CT scan. 1,9,12,14,15,22,24,25 If surgical principles guiding treatment in primary lesions are well established, management of pJAs and guidelines on surveillance is still controversial. pJA may be identified by imaging techniques or endoscopy during the postoperative course.…”

“…pJA may be identified by imaging techniques or endoscopy during the postoperative course. In our recent report on a relatively large series of 74 patients, the evolution and management of pJA were analyzed 12 in the attempt to better understand the behavior, optimize treatment, and minimize morbidity of pJA. As an additional aid to the management of unintentional pJAs, the present study focuses on the role of early postoperative MRI after endoscopic resection.…”