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
