Endoscopic Surgery for Juvenile Nasopharyngeal Angiofibroma

Objective: The purpose of this article is to present our experience with 16 patients diagnosed with JNA who were resected with endonasal endoscopic surgery.

Methods: Records of 16 patients whose ages ranged from 11 to 32 years (mean age, 19.5 years), who were treated by endoscopic surgery in our department between 2003 and 2010, were reviewed retrospectively. All patients were male. According to Radkowski's classification, four patients were stage Ia, five patients were stage Ib, four patients were stage IIa, and three patients were stage IIb. The tumor stages, feeding vessels, operating time, complications, and recurrence were observed and recorded. Eight patients received preoperative angiographic embolization and three patients received intraoperative external carotid artery clamping. Transnasal or transpterygoid and posterolateral wall of maxillary sinus approaches were used for tumor resection.

Results: The mean duration of the surgery was 2 hours. The mean intraoperative blood loss of patients who received preoperative hyperselective embolization was 470 mL, and for those who received intraoperative external carotid artery clamping it was 510 mL. In patients who did not receive arterial supply blocking, the blood loss was 930 mL. After surgery, CT scan or MR image showed total removal of the tumor was achieved in all patients. No postoperative complications were observed. All patients were followed up for 9 months to 3 years (mean, 1.5 years), during which no recurrence was found.

Conclusions: Endoscopic resection of JNA is a difficult but effective operation. The key technique to remove tumor is bleeding control. Endonasal surgery combined with a preoperative embolization of the arterial supply can control the blood loss. For small and intermediate-size JNA (Radkowski Ia–IIb), endoscopic surgery is an appropriate choice.