gms | German Medical Science

Introduction: The endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) emerges as an alternative approach to open surgical procedures due to reduced morbidity and comparable recurrence rates. The purpose of this study is to present our experience with the endoscopic management of JNA.

Patients/methods: Retrospective chart review of six male patients with mean age 14.6 years (range 10–21) who were treated endoscopically for JNA at our institution between the years 2003–2009. Two tumours were classified as stage I and 4 tumours as stage II according to the Fisch staging system. Three patients underwent preoperative embolisation. The endoscopic treatment 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 post operatively and then at yearly follow up.

Results: Mean follow up was 34 months (range 12–62). All but one patient were free of macroscopic disease. A patient with stage II JNA developed recurrence after 9 months. The residual tumour was resected endoscopically and the sphenopalatine foramen widened by drilling. The patient is free of disease 17 months postoperatively. The intra-operative blood loss was acceptable (450–800 ml, mean: 560ml) and no patient required a blood transfusion. Patients were discharged after 4 to 8 days (mean 5 days). No complications were reported.

Conclusions: Our results are in line with those of other investigators regarding the endoscopic management of stage I and II JNA. The endoscopic approach is a safe and effective treatment modality for JNA due to the lack of external scars, minimal bone resection and enhanced visualization of the tumour extent.