Download PDF
J Neurol Surg B Skull Base 2018; 79(01): 021-030
DOI: 10.1055/s-0037-1615810
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Juvenile Angiofibroma: Current Management Strategies

Ahmad Safadi
1   Department of Otorhinolaryngology – Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Alberto Schreiber
2   Department of Otorhinolaryngology – Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
,
Dan M. Fliss
1   Department of Otorhinolaryngology – Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Piero Nicolai
2   Department of Otorhinolaryngology – Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 January 2018 (online)

    Permissions and Reprints

Abstract

Juvenile angiofibroma (JA) is a benign, highly vascular tumor which is diagnosed on the basis of clinical and imaging features. It has a characteristic pattern of spread commonly involving the pterygopalatine fossa and pterygoid base. The mainstay of treatment is surgery, while radiotherapy is rarely used for the treatment of recurrent lesion. Endoscopic endonasal surgery is currently the treatment of choice for small to intermediate size JAs, and is feasible even for advanced lesions; however, this should only be practiced in well-experienced centers.

Keywords

juvenile angiofibroma - endoscopic surgery - surgical treatment of juvenile angiofibroma
 

  • References

  • 1 Lund VJ, Stammberger H, Nicolai P. , et al; European Rhinologic Society Advisory Board on Endoscopic Techniques in the Management of Nose, Paranasal Sinus and Skull Base Tumours. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; 22: 1-143
    PubMedGoogle Scholar
  • 2 Antonelli AR, Cappiello J, Di Lorenzo D, Donajo CA, Nicolai P, Orlandini A. Diagnosis, staging, and treatment of juvenile nasopharyngeal angiofibroma (JNA). Laryngoscope 1987; 97 (11) 1319-1325
    CrossrefPubMedGoogle Scholar
  • 3 Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Two types of lateral extension in juvenile nasopharyngeal angiofibroma: diagnostic and therapeutic management. Eur Arch Otorhinolaryngol 2015; 272 (01) 159-166
    CrossrefPubMedGoogle Scholar
  • 4 Zanation AM, Mitchell CA, Rose AS. Endoscopic skull base techniques for juvenile nasopharyngeal angiofibroma. Otolaryngol Clin North Am 2012; 45 (03) 711-730 , ix ix .
    CrossrefPubMedGoogle Scholar
  • 5 Danesi G, Panciera DT, Harvey RJ, Agostinis C. Juvenile nasopharyngeal angiofibroma: evaluation and surgical management of advanced disease. Otolaryngol Head Neck Surg 2008; 138 (05) 581-586
    CrossrefPubMedGoogle Scholar
  • 6 Sessions RB, Bryan RN, Naclerio RM, Alford BR. Radiographic staging of juvenile angiofibroma. Head Neck Surg 1981; 3 (04) 279-283
    CrossrefPubMedGoogle Scholar
  • 7 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
  • 8 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
  • 9 Onerci M, Oğretmenoğlu O, Yücel T. Juvenile nasopharyngeal angiofibroma: a revised staging system. Rhinology 2006; 44 (01) 39-45
    PubMedGoogle Scholar
  • 10 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
  • 11 Snyderman CH, Pant H. Endoscopic management of vascular sinonasal tumors, including angiofibroma. Otolaryngol Clin North Am 2016; 49 (03) 791-807
    CrossrefPubMedGoogle Scholar
  • 12 El Sharkawy AA. Endonasal endoscopic management of juvenile nasopharyngeal angiofibroma without angiographic embolization. Eur Arch Otorhinolaryngol 2013; 270 (07) 2051-2055
    CrossrefPubMedGoogle Scholar
  • 13 El-Banhawy OA, Ragab A, El-Sharnoby MM. Surgical resection of type III juvenile angiofibroma without preoperative embolization. Int J Pediatr Otorhinolaryngol 2006; 70 (10) 1715-1723
    CrossrefPubMedGoogle Scholar
  • 14 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
  • 15 Hackman T, Snyderman CH, Carrau R, Vescan A, Kassam A. Juvenile nasopharyngeal angiofibroma: the expanded endonasal approach. Am J Rhinol Allergy 2009; 23 (01) 95-99
    CrossrefPubMedGoogle Scholar
  • 16 Roger G, Tran Ba Huy P, Froehlich P. , et al. Exclusively endoscopic removal of juvenile nasopharyngeal angiofibroma: trends and limits. Arch Otolaryngol Head Neck Surg 2002; 128 (08) 928-935
    PubMedGoogle Scholar
  • 17 Santos-Franco JA, Lee A, Campos-Navarro LA, Tenorio-Sánchez J, Zenteno M, Osorio-Alvarado AR. Bilateral non-superselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note. Vasc Endovascular Surg 2012; 46 (07) 559-564
    CrossrefPubMedGoogle Scholar
  • 18 Lv MM, Fan XD, Su LX, Chen D. Preoperative direct puncture embolization of advanced juvenile nasopharyngeal angiofibroma in combination with transarterial embolization: an analysis of 22 consecutive patients. Cardiovasc Intervent Radiol 2013; 36 (01) 111-117
    CrossrefPubMedGoogle Scholar
  • 19 Lehmann M, Ulrich S, Reineke U, Hamberger U, Dietrich U, Sudhoff H. Intratumoral Onyx embolisation in the management of juvenile nasopharyngeal angiofibroma [in German]. HNO 2010; 58 (08) 853-857
    CrossrefPubMedGoogle Scholar
  • 20 Hira A, Chao K. Direct endoscopic intratumoral injection of Onyx for the preoperative embolization of a recurrent juvenile nasal angiofibroma. Interv Neuroradiol 2011; 17 (04) 477-481
    CrossrefPubMedGoogle Scholar
  • 21 Herman B, Bublik M, Ruiz J, Younis R. Endoscopic embolization with onyx prior to resection of JNA: a new approach. Int J Pediatr Otorhinolaryngol 2011; 75 (01) 53-56
    PubMedGoogle Scholar
  • 22 Aziz-Sultan MA, Moftakhar R, Wolfe SQ, Elhammady MS, Herman B, Farhat H. Endoscopically assisted intratumoral embolization of juvenile nasopharyngeal angiofibroma using Onyx. J Neurosurg Pediatr 2011; 7 (06) 600-603
    CrossrefPubMedGoogle Scholar
  • 23 Mishra A, Mishra SC, Verma V. , et al. In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma. J Laryngol Otol 2016; 130 (05) 462-473
    CrossrefPubMedGoogle Scholar
  • 24 Fisch U. The infratemporal fossa approach for nasopharyngeal tumors. Laryngoscope 1983; 93 (01) 36-44
    CrossrefPubMedGoogle Scholar
  • 25 Herman P, Lot G, Chapot R, Salvan D, Huy PT. Long-term follow-up of juvenile nasopharyngeal angiofibromas: analysis of recurrences. Laryngoscope 1999; 109 (01) 140-147
    CrossrefPubMedGoogle Scholar
  • 26 Pryor SG, Moore EJ, Kasperbauer JL. Endoscopic versus traditional approaches for excision of juvenile nasopharyngeal angiofibroma. Laryngoscope 2005; 115 (07) 1201-1207
    CrossrefPubMedGoogle Scholar
  • 27 Kamel RH. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma. J Laryngol Otol 1996; 110 (10) 962-968
    CrossrefPubMedGoogle Scholar
  • 28 Fagan JJ, Snyderman CH, Carrau RL, Janecka IP. Nasopharyngeal angiofibromas: selecting a surgical approach. Head Neck 1997; 19 (05) 391-399
    CrossrefPubMedGoogle Scholar
  • 29 Zicot AF, Daele J. Endoscopic surgery for nasal and sinusal vascular tumours: about two cases of nasopharyngeal angiofibromas and one case of turbinate angioma. Acta Otorhinolaryngol Belg 1996; 50 (03) 177-182
    PubMedGoogle Scholar
  • 30 Tseng HZ, Chao WY. Transnasal endoscopic approach for juvenile nasopharyngeal angiofibroma. Am J Otolaryngol 1997; 18 (02) 151-154
    CrossrefPubMedGoogle Scholar
  • 31 Mitskavich MT, Carrau RL, Snyderman CH, Weissman JL, Fagan JJ. Intranasal endoscopic excision of a juvenile angiofibroma. Auris Nasus Larynx 1998; 25 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 32 Bernal-Sprekelsen M, Vázquez AA, Pueyo J, Carbonell Casasús J. Endoscopic resection of juvenile nasopharyngeal fibromas [in German]. HNO 1998; 46 (02) 172-174
    CrossrefPubMedGoogle Scholar
  • 33 Nakamura H, Kawasaki M, Higuchi Y, Seki S, Takahashi S. Transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma with KTP laser. Eur Arch Otorhinolaryngol 1999; 256 (04) 212-214
    CrossrefPubMedGoogle Scholar
  • 34 Schick B, el Rahman el Tahan A, Brors D, Kahle G, Draf W. Experiences with endonasal surgery in angiofibroma. Rhinology 1999; 37 (02) 80-85
    PubMedGoogle Scholar
  • 35 Newlands SD, Weymuller Jr EA. Endoscopic treatment of juvenile nasopharyngeal angiofibroma. Am J Rhinol 1999; 13 (03) 213-219
    CrossrefPubMedGoogle Scholar
  • 36 Jorissen M, Eloy P, Rombaux P, Bachert C, Daele J. Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma. Acta Otorhinolaryngol Belg 2000; 54 (02) 201-219
    PubMedGoogle Scholar
  • 37 Khalifa MA. Endonasal endoscopic surgery for nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg 2001; 124 (03) 336-337
    CrossrefPubMedGoogle Scholar
  • 38 Carrau RL, Snyderman CH, Kassam AB, Jungreis CA. Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma. Laryngoscope 2001; 111 (03) 483-487
    CrossrefPubMedGoogle Scholar
  • 39 Ungkanont K, Byers RM, Weber RS, Callender DL, Wolf PF, Goepfert H. Juvenile nasopharyngeal angiofibroma: an update of therapeutic management. Head Neck 1996; 18 (01) 60-66
    CrossrefPubMedGoogle Scholar
  • 40 Nicolai P, Berlucchi M, Tomenzoli D. , et al. Endoscopic surgery for juvenile angiofibroma: when and how. Laryngoscope 2003; 113 (05) 775-782
    CrossrefPubMedGoogle Scholar
  • 41 Onerci TM, Yücel OT, Oğretmenoğlu O. Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol 2003; 67 (11) 1219-1225
    CrossrefPubMedGoogle Scholar
  • 42 Wormald PJ, Van Hasselt A. Endoscopic removal of juvenile angiofibromas. Otolaryngol Head Neck Surg 2003; 129 (06) 684-691
    PubMedGoogle Scholar
  • 43 Pasquini E, Sciarretta V, Frank G. , et al. Endoscopic treatment of benign tumors of the nose and paranasal sinuses. Otolaryngol Head Neck Surg 2004; 131 (03) 180-186
    CrossrefPubMedGoogle Scholar
  • 44 Cloutier T, Pons Y, Blancal JP. , et al. Juvenile nasopharyngeal angiofibroma: does the external approach still make sense?. Otolaryngol Head Neck Surg 2012; 147 (05) 958-963
    CrossrefPubMedGoogle Scholar
  • 45 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
  • 46 Langdon C, Herman P, Verillaud B. , et al. Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study. Rhinology 2016; 54 (03) 239-246
    PubMedGoogle Scholar
  • 47 Schreiber A, Ferrari M, Rampinelli V. , et al. Modular endoscopic medial maxillectomies: quantitative analysis of surgical exposure in a preclinical setting. World Neurosurg 2017; 100: 44-55
    CrossrefPubMedGoogle Scholar
  • 48 Howard DJ, Lloyd G, Lund V. Recurrence and its avoidance in juvenile angiofibroma. Laryngoscope 2001; 111 (09) 1509-1511
    CrossrefPubMedGoogle Scholar
  • 49 Jones GC, DeSanto LW, Bremer JW, Neel III HB. Juvenile angiofibromas. Behavior and treatment of extensive and residual tumors. Arch Otolaryngol Head Neck Surg 1986; 112 (11) 1191-1193
    CrossrefPubMedGoogle Scholar
  • 50 Boghani Z, Husain Q, Kanumuri VV. , et al. Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases. Laryngoscope 2013; 123 (04) 859-869
    CrossrefPubMedGoogle Scholar
  • 51 Cummings BJ, Blend R, Keane T. , et al. Primary radiation therapy for juvenile nasopharyngeal angiofibroma. Laryngoscope 1984; 94 (12 Pt 1): 1599-1605
    PubMedGoogle Scholar
  • 52 Lee JT, Chen P, Safa A, Juillard G, Calcaterra TC. The role of radiation in the treatment of advanced juvenile angiofibroma. Laryngoscope 2002; 112 (7 Pt 1): 1213-1220
    PubMedGoogle Scholar
  • 53 Fields JN, Halverson KJ, Devineni VR, Simpson JR, Perez CA. Juvenile nasopharyngeal angiofibroma: efficacy of radiation therapy. Radiology 1990; 176 (01) 263-265
    CrossrefPubMedGoogle Scholar
  • 54 Reddy KA, Mendenhall WM, Amdur RJ, Stringer SP, Cassisi NJ. Long-term results of radiation therapy for juvenile nasopharyngeal angiofibroma. Am J Otolaryngol 2001; 22 (03) 172-175
    CrossrefPubMedGoogle Scholar
  • 55 McAfee WJ, Morris CG, Amdur RJ, Werning JW, Mendenhall WM. Definitive radiotherapy for juvenile nasopharyngeal angiofibroma. Am J Clin Oncol 2006; 29 (02) 168-170
    CrossrefPubMedGoogle Scholar
  • 56 Amdur RJ, Yeung AR, Fitzgerald BM, Mancuso AA, Werning JW, Mendenhall WM. Radiotherapy for juvenile nasopharyngeal angiofibroma. Pract Radiat Oncol 2011; 1 (04) 271-278
    CrossrefPubMedGoogle Scholar
  • 57 Chakraborty S, Ghoshal S, Patil VM, Oinam AS, Sharma SC. Conformal radiotherapy in the treatment of advanced juvenile nasopharyngeal angiofibroma with intracranial extension: an institutional experience. Int J Radiat Oncol Biol Phys 2011; 80 (05) 1398-1404
    CrossrefPubMedGoogle Scholar
  • 58 Dare AO, Gibbons KJ, Proulx GM, Fenstermaker RA. Resection followed by radiosurgery for advanced juvenile nasopharyngeal angiofibroma: report of two cases. Neurosurgery 2003; 52 (05) 1207-1211 , discussion 1211
    PubMedGoogle Scholar
  • 59 Álvarez FL, Suárez V, Suárez C, Llorente JL. Multimodality approach for advanced-stage juvenile nasopharyngeal angiofibromas. Head Neck 2013; 35 (02) 209-213
    CrossrefPubMedGoogle Scholar
  • 60 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