Juvenile nasopharyngeal angiofibroma stages I and II: A comparative study of surgical approaches

Background: Juvenile nasopharyngeal angiofibroma is a vascular malformation rather than true neoplasm. It accounts for 0.5% of all head and neck tumors and its general incidence is 1:150,000. It is uncommon, benign, extremely vascular tumor that arises from tissues in the sphenopalatine foramen, the pterygoid base causing Early spread submucosally towards nasopharynx. Surgical excision is mainstay of treatment.Methods: This is a retrospective observational study carried out from March 2002 to March 2019, 130 patients underwent surgical resection of juvenile nasopharyngeal angiofibroma at Civil Hospital, Ahmedabad. Patients were divided in two groups with Group-A having patients from 2002-2010 and Group B having patients from 2011-2019.Results: A total 130 cases of juvenile nasopharyngeal angiofibroma with a mean age of 16.25 years (range 9-33) were treated by surgical excision from March 2002 to March 2019. In Group A patients open approach was used most often with endoscopic approach used only till stage II-A. In Group B patients the preferred surgical approach was trans-nasal endoscopic approach cases up to stage IV-A and open approach including the midfacial degloving approach and infratemporal approach was used cases with extensive intracranial, lateral infratemporal fossa, orbit, optic nerve, cavernous sinus involvement.Conclusions: Our study shows that over the years there has been shift in surgical approaches used in treating angiofibroma with the advent of newer endoscopic method and addition of various technology such as coblation, navigation has made the procedure for a highly vascular tumor simpler.

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Juvenile Nasopharyngeal Angiofibroma: Diagnosis and Treatment

Otolaryngology ◽

10.1177/019459988709700604 ◽

1987 ◽

Vol 97 (6) ◽

pp. 534-540 ◽

Cited By ~ 39

Author(s):

Arndt J. Duvall ◽

Alex E. Moreano

Keyword(s):

Benign Lesion ◽

Ct Scanning ◽

Operative Management ◽

Vascular Tumor ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Surgical Approaches ◽

Nasopharyngeal Angiofibroma ◽

Primary Treatment Modality ◽

Fatal Hemorrhage ◽

Incomplete Removal

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon, histologically benign vascular tumor that occurs almost exclusively in adolescent males. While occasional mention is made of the occurrence of JNA in females and in older males, only four1 cases have withstood rigorous clinicopathological review. This neoplasm accounts for less than 0.05% of all benign lesions that originate in the nasopharynx. Its clinically malignant behavior is a result of its propensity for locally destructive growth and fatal hemorrhage. The evolution in the management of these tumors has been the subject of much interest and much confusion. The advents of computed tomographic (CT) scanning, selective angiography with embolization, and refinements in surgical approaches have revolutionized operative management of these lesions by allowing more realistic selection of surgical candidates, better preoperative planning, and more flexible (yet aggressive) primary surgical treatment. The attendant reduction in morbidity and mortality of contemporary surgical management of this disease has largely obviated the argument of those who advocate use of radiotherapy as the primary treatment modality for this benign lesion. This latter view is based on the reports of massive hemorrhage, significant incidence of incomplete removal, and mortality reported in the older surgical literature. This article details our experience with a series of 31 patients who had clinicopathological diagnoses of JNA and were treated between 1954 and 1984. It furthermore represents an update of our previously reported series.2

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Surgical approaches to juvenile nasopharyngeal angiofibroma

Operative Techniques in Otolaryngology-Head and Neck Surgery ◽

10.1016/s1043-1810(01)80024-5 ◽

2001 ◽

Vol 12 (4) ◽

pp. 214-218 ◽

Cited By ~ 3

Author(s):

Boaz Forer ◽

Ari Derowe ◽

Jacob T. Cohen ◽

Roee Landsberg ◽

Ziv Gil ◽

...

Keyword(s):

Juvenile Nasopharyngeal Angiofibroma ◽

Surgical Approaches ◽

Nasopharyngeal Angiofibroma

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Multiport Combined Endoscopic Approach to Nonembolized Juvenile Nasopharyngeal Angiofibroma with Parapharyngeal Extension: An Emerging Concept

International Journal of Otolaryngology ◽

10.1155/2016/4203160 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Tiruchy Narayanan Janakiram ◽

Shilpee Bhatia Sharma ◽

Vijayshree Nahata Gattani

Keyword(s):

Parapharyngeal Space ◽

Case Series ◽

Residual Tumor ◽

Disease Recurrence ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Surgical Approaches ◽

Transoral Surgery ◽

Endoscopic Endonasal ◽

Nasopharyngeal Angiofibroma ◽

One Year

Background. Surgical approaches to the parapharyngeal space (PPS) are challenging by virtue of deep location and neurovascular content. Juvenile Nasopharyngeal Angiofibroma (JNA) is a formidable hypervascular tumor that involves multiple compartments with increase in size. In tumors with extension to parapharyngeal space, the endonasal approach was observed to be inadequate. Combined Endoscopic Endonasal Approaches and Endoscopic Transoral Surgery (EEA-ETOS) approach has provided a customized alternative of multicorridor approach to access JNA for its safe and efficient resection.Methods. The study demonstrates a case series of patients of JNA with prestyloid parapharyngeal space extension operated by endoscopic endonasal and endoscopic transoral approach for tumor excision.Results. The multiport EEA-ETOS approach was used to provide wide exposure to access JNA in parapharyngeal space. No major complications were observed. No conversion to external approach was required. Postoperative morbidity was low and postoperative scans showed no residual tumor. A one-year follow-up was maintained and there was no evidence of disease recurrence.Conclusion. Although preliminary, our experience demonstrates safety and efficacy of multiport approach in providing access to multiple compartments, facilitating total excision of JNA in selected cases.

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Management and Outcome in Patients with Advanced Juvenile Nasopharyngeal Angiofibroma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1608658 ◽

2017 ◽

Vol 79 (04) ◽

pp. 353-360 ◽

Cited By ~ 3

Author(s):

Vedantam Rupa ◽

Sunithi Mani ◽

Selvamani Backianathan ◽

Vedantam Rajshekhar

Keyword(s):

Residual Disease ◽

Tertiary Care ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Surgical Approaches ◽

Open Approach ◽

Nasopharyngeal Angiofibroma ◽

Expanded Endonasal Approach ◽

Lost To Follow Up ◽

Disease Free

Objective To report the management outcome in a series of patients with advanced juvenile nasopharyngeal angiofibroma (JNA). Design Retrospective study. Setting Tertiary care teaching hospital. Participants Forty-five patients classified as Radkowski stage IIIA or IIIB who presented to us over the past 10 years. Main Outcome Measures Surgical approaches used and disease free outcomes in patients with advanced JNA. Results Surgical access for the extracranial component included open (41.9%) and expanded endonasal approaches (58.1%). Craniotomy (16.3%), endoscopy-assisted open approach (7%), or expanded endonasal approach (20.9%) was performed to excise the skull base or intracranial component. Follow up ranged from 4 to 96 months (mean, 20.3 months). Of 35 patients who underwent imaging at the first postoperative follow up, 25 (71.4%) had negative scans. Three symptomatic patients with residual disease underwent endoscopic excision and had negative scans thereafter. Of two others who had radiation therapy, one was disease free and the other lost to follow up. Five others had stable, residual disease. Three patients (8.6%) with recurrent disease underwent surgical excision, of whom two had minimal, stable residual disease. At the last follow-up, 27 (77.1%) patients had negative scans, and 7 (20%) had stable residual disease with one (2.9%) patient lost to follow-up. Conclusions Advanced JNA may be successfully treated in most cases with expanded endonasal/endoscopy assisted ± craniotomy approach after appropriate preoperative evaluation. At follow-up, only symptomatic patients or those with enlarging residue require treatment; periodic imaging surveillance is adequate for those with stable disease.

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