Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular and locally invasive tumor with a high incidence of persistence and recurrence. The classical treatment of this tumor is surgery and/or radiotherapy. Use of endoscopic techniques seems to be on the rise in treatment of these lesions. We tried to explore the roles and limits of endoscopic surgery alone or with classical surgical techniques in treatment of these tumors.

Retrospective case review was conducted at a tertiary referral center. Twelve patients were treated for nasopharyngeal angiofibroma using endoscopic approach between 1998-2002. The staging, average blood loss during surgery, residual, and/or recurrent tumor were evaluated.

Eight of these patients (8/12) were up to stage IIC according to Radkowski staging. This group of patients has an average blood loss of 1000 ml and were followed for at least 6 months. We did not encounter any residual or recurrent tumor in this group. Four patients (4/12) had minimal intracranial extension, were staged IIIA, and had an average blood loss of 1500 ml during surgery. Two of these patients had minimal residual tumor around the cavernous sinus, but showed no progression of disease over a follow-up of 2 years with MRI. Two patients had no residual or recurrent tumor over a follow-up of 6 months.

This data suggests that endoscopic surgery can be used in the treatment of JNA even with minimal intracranial extension with minimal morbidity and low recurrence rate.