Juvenile Nasopharyngeal Angiofibromas: Choice of the Procedure as Regards Orbit and Optic Nerve

Objectives: Juvenile nasopharyngeal angiofibromas develop in teenagers, for whom the concept of minimally invasive procedure is especially relevant. However, spontaneous development of the tumor as well as aggressive therapeutic management may threaten the vision.

Now that endoscopic removal has become the procedure of choice for JNA, the goal of this study is to determine whether tumor extensions within the orbit or around the optic nerve are contraindications for the endoscopic approach.

Patients and Methods: This retrospective study included all patients operated on between 2000 and 2011. Tumor extensions, particularly to the inferior orbital fissure, the orbital apex, the cavernous sinus, and the optic canal were analyzed. The correlation between putative extensions to the orbit apex or around the optic nerve and choice of approach was studied.

Results: Seventy patients were treated from 2000 to 2011, and 72 surgical procedures were done including 48 endoscopic approaches.

Before 2006, there were 11 extensions to the orbit, which all warranted a degloving approach. Since then, 11 patients out of 41—with extensions to the inferior orbital fissure, to the orbital apex, or the cavernous sinus—were treated by an endoscopic approach with a favorable outcome. Only two patients with orbital extension were treated with an open approach.

Conclusion: Thanks to the improvement in lateral endonasal exposure provided by medial maxillectomy, most of the orbital extensions can be removed safely via the endoscopic approach. Only massive extensions to the cavernous sinus, around the optic nerve or the chiasma, remain indisputable indications for an external approach.