Discussion on endoscopic staging system for juvenile nasopharyngeal angiofibroma

Abstract

Objective To develop a new staging system for juvenile nasopharyngeal angiofibroma that reflects changes in surgical approaches (endonasal),route of intracranial extension,and the extent of vascular supply from the internal carotid artery.Method Retrospective review was used to study the series cases.35 patients had undergone endoscopic endonasal surgery for JNA,from 2005 to 2011.Patients were staged according to current systems and compared with a new staging system that also incorporated the route of skull base extension and tumor vascularity.Estimated blood loss,number of operations,and tumor recurrence as main outcome measures were observed.Results Skull base erosion was observed in 74％ of cases.Following embolization of external carotid artery tributaries,residual vascularity from the internal carotid artery was seen in 51％ of patients.Residual vascularity,classified as our stage Ⅳ and Ⅴ,was strongly correlated with blood loss,requirement for multiple procedures,and residual or recurrent tumor.Conclusion Tumor size and extent of sinus disease were less important in predicting complete tumor removal with endonasal surgical techniques.This staging system for JNA accounted for 2 important prognostic factors,route of cranial base extension,and vascularity,which were applicable to endoscopic or open approaches.Compared with other staging systems,this staging system provides a better prediction of immediate morbidity (including blood loss and need for multiple operations) and tumor recurrence. Key words: Angiofibroma; Nasopharyngeal; Endoscope; Staging system