Endonasal endoscopic management of juvenile nasopharyngeal angiofibroma without angiographic embolization

The objective of the study was to present our experience with definitive endonasal endoscopic management of patients with Radkowski stage IA&B and IIA Juvenile nasopharyngeal angiofibroma (JNAs) without preoperative angiographic embolization. This was a retrospective study performed at tertiary referral center. 18 males with JNAs stage IA&B and II A according to Radkowski classification were included in this study. Their ages ranged from 14 to 23 years with a mean of 16.7 years. All patients were presented by nasal obstruction with recurrent epistaxis in 15 patients. All the patients underwent computed tomography and magnetic resonance imaging to delineate the extent and location of the tumor. Neither angiography nor embolization was done for any patient preoperatively. An endonasal endoscopic technique was used for excision of the tumors in all patients. Complete removal of the tumor was achieved in 16 patients with no residual or recurrent tumor. Two patients had residual tumors: the recurrence in the lateral wall of the sphenoid sinus in the first patient and in the pterygopalatine fossa in the other patient. Follow-up ranged from 14 to 72 months with a mean of 37.4 months. The mean of intraoperative blood loss was 342.3 ± 92.7 ml. The endonasal endoscopic approach is a safe and effective technique for small- and intermediate-sized JNAs (stage IA&B and IIA) without preoperative angiographic embolization. Hypotensive anesthesia, meticulous dissection as well as diathermy of the sphenopalatine artery greatly decrease the blood loss.