gms | German Medical Science

Introduction: The endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) emerges as an alternative approach to open procedures due to reduced morbidity and comparable recurrence rates.

Methods: We review eleven male patients (mean age 14.6 years) with JNA who were treated endoscopically at our institution between the years 2003–2009. Based on the Radkowski staging system, tumors were classified as stage Ia (two), stage Ib (two), stage IIa (three), stage IIb (two) and stage IIc (two). Five patients underwent preoperative embolisation. The procedure involved posterior ethmoidectomy, middle meatal antrostomy, sphenoidotomy, clipping of the sphenopalatine artery and its branches and drilling of the pterygoid basis. All patients underwent magnetic resonance imaging 3 months postoperatively and then if indicated clinically.

Results: All but one patient were free of macroscopic disease after a mean follow up of 24.1 months. A patient with stage IIb JNA developed recurrence after 9 months and was successfully re-operated endoscopically. The intra-operative blood loss was not excessive (mean 535 ml) and no patient required a blood transfusion. Patients were discharged after 4 to 8 days. No complications were reported.

Conclusions: We propose that the endoscopic approach for JNAs up to stage IIc is a safe and effective treatment modality. Larger tumors may also be operated endoscopically with or without limited external approaches by experienced surgeons.