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Exclusively Endoscopic Removal of Juvenile Nasopharyngeal Angiofibroma
Trends and Limits
Gilles Roger, MD;
Patrice Tran Ba Huy, MD;
Patrick Froehlich, MD, PhD;
Thierry Van Den Abbeele, MD, PhD;
Jean-Michel Klossek, MD;
Elie Serrano, MD;
Erea-Noel Garabedian, MD;
Philippe Herman, MD, PhD
Arch Otolaryngol Head Neck Surg. 2002;128:928-935.
Objective To determine the feasible conditions for exclusive endoscopic resection
of juvenile nasopharyngeal angiofibroma.
Design Retrospective study of 20 patients, with a mean follow-up of 22 months.
Setting Six academic referral hospitals.
Interventions All patients had a preoperative computed tomographic or magnetic resonance
imaging scan and at least 1 follow-up computed tomographic and/or magnetic
resonance imaging scan 6 or 12 months after surgery. Exclusive endoscopic
removal was performed using conventional functional endoscopic sinus surgery
instrumentation after preoperative embolization.
Results Using Radkowski staging, 4, 7, and 9 patients had stage I, II and IIIA
tumors, respectively. Seven patients were operated on for a recurrence after
open surgery. Extension toward the sphenoid sinus, pterygomaxillary fossa,
or infratemporal fossa could be removed. There was no attempt at endoscopic
removal of deep skull base or temporal fossa invasion. The mean surgery duration
was 135 minutes; mean dimensions of the tumor were 4.5 x 4 x 3
cm; and mean blood loss was 350 mL (median, 300 mL). No recurrences occurred
in this series; there were small asymptomatic remnants in 2 cases.
Conclusions An exclusively endoscopic management of juvenile nasopharyngeal angiofibroma
appears to be effective for small to medium tumors. It should be considered
as a first-choice option for these cases (in view of the minimal bleeding,
shorter duration, and efficacy).
From the Ear, Nose, and Throat and Head and Neck Surgery Departments,
Armand-Trousseau Children's Hospital, Assistance Publique-Hôpitaux de
Paris, Paris (Drs Roger and Garabedian); Lariboisière Hospital, Assistance
Publique-Hôpitaux de Paris, Paris (Drs Tran Ba Huy and Herman); Edouard
Herriot Hospital, Hospices Civils de Lyon, Lyon (Dr Froehlich); Robert Debré
Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris (Dr
Van Den Abbeele); Jean Bernard Hospital, Poitiers, France (Dr Klossek); and
Rangueil Hospital, Toulouse (Dr Serrano), France.
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ABSTRACT
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