Endoscopic versus Traditional Craniofacial Approaches in Management of Juvenile Nasopharyngeal Angiofibromas

Background: Surgical management of juvenile nasopharyngeal angiofibromas (JNA) has traditionally been through craniofacial techniques. Endoscopic approaches to sinonasal tumors are now commonly performed in a safe and efficacious manner. For JNAs, in combination with pre-operative embolization, complete resection with recurrence rates similar to traditional approaches is possible.

Methods: Retrospective review of 43 patients treated at the University of Michigan from 1997 to 2012. Ten patients were managed endoscopically and thirty-three patients were managed through traditional open techniques. Comparisons of tumor volume, anatomic extension of disease, completeness of resection, blood loss, length of hospitalization, recurrence rates, and complications were performed with appropriate sensitivity analyses.

Results: Tumors resected endoscopically were smaller on average than those removed via an open approach (60.6 cm3 vs 115.7 cm3). The tumors had similar rates of intracranial extension (30% endoscopic v 35.7% open) and had similar rates of initial complete resection (80% complete endoscopically vs 78% complete open). Revision rates were higher in the patients undergoing open procedures. Shorter operative times and length of hospitalization as well as significantly less blood loss was noted with the endoscopic approach.

Conclusion: Surgical management of juvenile nasopharyngeal angiofibromas continues to evolve. Large tumors can often be safely removed endoscopically and can lead to decreased intraoperative blood loss, fewer blood transfusions, shorter hospitalization, and possibly fewer re-operations. There is still a role for open resections and pre-operative embolization continues to prove valuable for all surgical approaches to decrease intra-operative blood loss.