Juvenile Nasopharyngeal Angiofibroma—The Pittsburgh Experience

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressively vascular tumor that may involve the skull base and extend intracranially. Endoscopic excision has become the new standard for smaller tumors but remains a challenge for large tumors. We reviewed our experience to define prognostic factors for endoscopic management using the expanded endonasal approach (EEA).

Methods: All cases of JNA at the University of Pittsburgh Medical Center from 1995 to 2006 were reviewed with respect to tumor size and location, vascular supply and results of embolization, skull base involvement and intracranial extension, surgical approach, blood loss, intraoperative and postoperative complications, and recurrence.

Results: Forty cases of JNA were identified. The majority of tumors were completely excised using the EEA, regardless of size or extension into adjacent compartments. Surgical excision of some tumors with intracranial blood supply was staged. Recurrence rates were not associated with extent of tumor or surgical technique. Long-term morbidity was minimal.

Conclusion: Most JNA may be completely excised with the EEA with avoidance of the morbidity associated with open approaches. Even JNAs with skull base extension and cavernous sinus extension are amenable to endoscopic resection.