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J Neurol Surg B Skull Base 2022; 83(S 02): e266-e273
DOI: 10.1055/s-0041-1725031
Original Article

Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

Salomon Cohen-Cohen 
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
,
Kristen M. Scheitler
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
,
Garret Choby
2   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Jeffrey Janus
2   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Eric J. Moore
2   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Jan L. Kasperbauer
2   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Harry J. Cloft
3   Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
,
Michael Link
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
2   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Jamie J. Van Gompel 
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
2   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures.

Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center.

Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort.

Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.

Keywords

juvenile nasopharyngeal angiofibroma - epistaxis - endoscopic - embolization


Publication History

Received: 11 August 2020

Accepted: 13 January 2021

Article published online:
02 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Glad H, Vainer B, Buchwald C. et al. Juvenile nasopharyngeal angiofibromas in Denmark 1981-2003: diagnosis, incidence, and treatment. Acta Otolaryngol 2007; 127 (03) 292-299
    CrossrefPubMedGoogle Scholar
  • 2 Gullane PJ, Davidson J, O'Dwyer T, Forte V. Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 1992; 102 (08) 928-933
    CrossrefPubMedGoogle Scholar
  • 3 López F, Triantafyllou A, Snyderman CH. et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017; 39 (05) 1033-1045
    CrossrefPubMedGoogle Scholar
  • 4 Liu JK, Husain Q, Kanumuri V, Khan MN, Mendelson ZS, Eloy JA. Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach. J Neurosurg 2016; 124 (05) 1328-1338
    CrossrefPubMedGoogle Scholar
  • 5 Leong SC. A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope 2013; 123 (05) 1125-1131
    CrossrefPubMedGoogle Scholar
  • 6 Hagen R, Romalo G, Schwab B, Hoppe F, Schweikert H-U. Juvenile nasopharyngeal fibroma: androgen receptors and their significance for tumor growth. Laryngoscope 1994; 104 (09) 1125-1129
    CrossrefPubMedGoogle Scholar
  • 7 Handousa FH, Farid H, Elwi AM. Nasopharyngeal fibroma; a clinico-pathological study of seventy cases. J Laryngol Otol 1954; 68 (10) 647-666
    CrossrefPubMedGoogle Scholar
  • 8 Harrison DF. The natural history, pathogenesis, and treatment of juvenile angiofibroma. Personal experience with 44 patients. Arch Otolaryngol Head Neck Surg 1987; 113 (09) 936-942
    CrossrefPubMedGoogle Scholar
  • 9 Sennes LU, Butugan O, Sanchez TG, Bento RF, Tsuji DH. Juvenile nasopharyngeal angiofibroma: the routes of invasion. Rhinology 2003; 41 (04) 235-240
    PubMedGoogle Scholar
  • 10 Radkowski D, McGill T, Healy GB, Ohlms L, Jones DT. Angiofibroma. Changes in staging and treatment. Arch Otolaryngol Head Neck Surg 1996; 122 (02) 122-129
    CrossrefPubMedGoogle Scholar
  • 11 Andrews JC, Fisch U, Valavanis A, Aeppli U, Makek MS. The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. Laryngoscope 1989; 99 (04) 429-437
    CrossrefPubMedGoogle Scholar
  • 12 Snyderman CH, Pant H, Carrau RL, Gardner P. A new endoscopic staging system for angiofibromas. Arch Otolaryngol Head Neck Surg 2010; 136 (06) 588-594
    CrossrefPubMedGoogle Scholar
  • 13 Onerci M, Oğretmenoğlu O, Yücel T. Juvenile nasopharyngeal angiofibroma: a revised staging system. Rhinology 2006; 44 (01) 39-45
    PubMedGoogle Scholar
  • 14 Lutz J, Holtmannspötter M, Flatz W. et al. Preoperative embolization to improve the surgical management and outcome of juvenile nasopharyngeal angiofibroma (JNA) in a single center: 10-year experience. Clin Neuroradiol 2016; 26 (04) 405-413
    CrossrefPubMedGoogle Scholar
  • 15 Pryor SG, Moore EJ, Kasperbauer JL. Endoscopic versus traditional approaches for excision of juvenile nasopharyngeal angiofibroma. Laryngoscope 2005; 115 (07) 1201-1207
    CrossrefPubMedGoogle Scholar
  • 16 Reyes C, Bentley H, Gelves JA, Solares CA, Byrd JK. Recurrence rate after endoscopic vs. open approaches for juvenile nasopharyngeal angiofibroma: a meta-analysis. J Neurol Surg B Skull Base 2019; 80 (06) 577-585
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Roche P-H, Paris J, Régis J. et al. Management of invasive juvenile nasopharyngeal angiofibromas: the role of a multimodality approach. Neurosurgery 2007; 61 (04) 768-777 , discussion 777
    CrossrefPubMedGoogle Scholar
  • 18 Safadi A, Schreiber A, Fliss DM, Nicolai P. Juvenile angiofibroma: current management strategies. J Neurol Surg B Skull Base 2018; 79 (01) 21-30
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Kalani MYS, Kalani MA, Kalb S. et al. Craniofacial approaches to large juvenile angiofibromas. J Neurosurg Pediatr 2011; 8 (01) 71-78
    CrossrefPubMedGoogle Scholar
  • 20 Fagan JJ, Snyderman CH, Carrau RL, Janecka IP. Nasopharyngeal angiofibromas: selecting a surgical approach. Head Neck 1997; 19 (05) 391-399
    CrossrefPubMedGoogle Scholar
  • 21 Enepekides DJ. Recent advances in the treatment of juvenile angiofibroma. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (06) 495-499
    CrossrefPubMedGoogle Scholar
  • 22 Santaolalla F, Araluce I, Zabala A, López A, Garay M, Sanchez JM. Efficacy of selective percutaneous embolization for the treatment of intractable posterior epistaxis and juvenile nasopharyngeal angiofibroma (JNA). Acta Otolaryngol 2009; 129 (12) 1456-1462
    CrossrefPubMedGoogle Scholar
  • 23 Moulin G, Chagnaud C, Gras R. et al. Juvenile nasopharyngeal angiofibroma: comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovasc Intervent Radiol 1995; 18 (03) 158-161
    CrossrefPubMedGoogle Scholar
  • 24 Overdevest JB, Amans MR, Zaki P, Pletcher SD, El-Sayed IH. Patterns of vascularization and surgical morbidity in juvenile nasopharyngeal angiofibroma: A case series, systematic review, and meta-analysis. Head Neck 2018; 40 (02) 428-443
    CrossrefPubMedGoogle Scholar
  • 25 Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009; 113 (15) 3406-3417
    CrossrefPubMedGoogle Scholar
  • 26 Carrau RL, Snyderman CH, Kassam AB, Jungreis CA. Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma. Laryngoscope 2001; 111 (03) 483-487
    CrossrefPubMedGoogle Scholar
  • 27 Mattavelli D, Rampinelli V, Ferrari M, Schreiber A, Guarneri B, Nicolai P. Long-term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma. Laryngoscope 2019; 129 (09) 2184-2188
    CrossrefPubMedGoogle Scholar
  • 28 Abdelwahab M, Overdevest JB, Elmokadem A. et al. Nasopharyngeal angiofibroma staging with a novel nominal basis: an 18-year study in a tertiary center. Otolaryngol Head Neck Surg 2019; 161 (02) 352-361
    CrossrefPubMedGoogle Scholar
  • 29 Mujtaba Khan M, Sudarshan Reddy L, Venkatram Reddy N, Ranganath Swamy D. Juvenile nasopharyngeal angiofibroma: our experience in a tertiary hospital. Indian J Otolaryngol Head Neck Surg 2018; 70 (02) 273-277
    CrossrefPubMedGoogle Scholar
  • 30 Nicolai P, Villaret AB, Farina D. et al. Endoscopic surgery for juvenile angiofibroma: a critical review of indications after 46 cases. Am J Rhinol Allergy 2010; 24 (02) e67-e72
    CrossrefPubMedGoogle Scholar
  • 31 Huang Y, Liu Z, Wang J, Sun X, Yang L, Wang D. Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012. Laryngoscope 2014; 124 (08) 1942-1946
    CrossrefPubMedGoogle Scholar
  • 32 Pamuk AE, Özer S, Süslü AE, Akgöz A, Önerci M. Juvenile nasopharyngeal angiofibroma: a single centre's 11-year experience. J Laryngol Otol 2018; 132 (11) 978-983
    CrossrefPubMedGoogle Scholar
  • 33 Thakar A, Hota A, Bhalla AS, Gupta SD, Sarkar C, Kumar R. Overt and occult vidian canal involvement in juvenile angiofibroma and its possible impact on recurrence. Head Neck 2016; 38 (Suppl. 01) E421-E425
    CrossrefPubMedGoogle Scholar
  • 34 Tyagi I, Syal R, Goyal A. Recurrent and residual juvenile angiofibromas. J Laryngol Otol 2007; 121 (05) 460-467
    CrossrefPubMedGoogle Scholar
  • 35 Celik B, Erisen L, Saraydaroglu O, Coskun H. Atypical angiofibromas: a report of four cases. Int J Pediatr Otorhinolaryngol 2005; 69 (03) 415-421
    CrossrefPubMedGoogle Scholar