Treatment Outcome of JNA: Retrospective Analysis of 23 Patients Treated with Endoscopic and Combined Endoscopic-Transcranial Approach

Our purpose is to analyze a cohort of 23 patients affected by JNA (juvenile nasopharyngeal angiofibroma) treated at our institutions from 1999 to 2006 chiefly with endonasal-endoscopic surgery (EES). We take into account data regarding EES related to the clinical stage using the Andrews-Fisch staging system. Current contributions present in the literature will allow a comparison between our results and the traditional approach to validate endoscopic treatment of JNA. All patients were male with an average age of 20 years (range, 10 to 49 yrs). Twenty-one have been treated merely endoscopically, 2 at stage I; 8 at stage II; 7 at stage IIIa; 4 at stage IIIb. Two of these patients, one at stage IIIa and the second at IIIb, were admitted as recurrences of previous surgery. Two underwent combined approaches: 1 with transcranial lateral before nasal endoscopy at stage IVb due to intradural extent and 1 with lateral rhinotomy at stage IIIb. Patients complained of nasal obstruction (n = 22, 96%), epistaxis (n = 17, 74%), headache (n = 3, 13%), proptosis (n = 1), dyplopia (n = 1), facial pain (n = 1), epilepsy (n = 1), and nausea (n = 1, 4.3%). Preoperative work-up included office evaluation, MRI, and CT. Twenty-four hours before surgery all patients were studied with ultraselective angiography and consensual catheter embolization of the tumor mass vascular supply with polyvinyl alcohol microspheres. None of the patients presented major complications after surgery, although 7 cases required blood transfusion. All patients were scheduled for 6-month MRI and 1-year follow-up angiography. Office control with nasal endoscopy followed surgery at 1, 3, and 6 months. Within the group of patients treated purely endoscopically we observed 4 recurrences with 1 patient operated at stage IIIa and 3 patients at stage IIIb; just 1 of these patients belonging to stage IIIb underwent second surgery for outgrowing the mass; he is now free from disease. The others are under strict follow-up cause residual lesion is steady. The success rate of EES appears to be 81% while relating to stages I, II, IIIa reaches 94%. Among patients treated with open surgery we counted 1 recurrence but available data are still limited. Our results at tumor stages I, II, and IIIa compared with same-stage reports of other authors regarding the transfacial approach show a similar success rate. In conclusion, this “minimally invasive” operation is able to achieve encouraging results, avoiding damage to craniofacial bone growth centers and facial scarring, with less postoperative pain and a shorter hospital stay.