History and modern aspects of treatment of juvenile nasopharyngeal angiofibroma

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor that is clinically manifested by epistaxis, usually occurs in males aged 9–27 years and accounts for approximately 0.5% of all head and neck tumors. The article presents historical data on the diagnosis and treatment of JNA. Modern views on the etiology of JNA are also represented. The development of such areas of medicine as anesthesiology (intubation, adequate analgesia and anesthesia, hemosubstitution, resuscitation), neuroradiology, endovascular surgery contributed to a further push in solving the problem of JNA. Attempts to visualize and treat this tumor have accompanied the evolution of the surgical treatment of juvenile nasopharyngeal angiofibroma. Today, the problem of JNA surgery is one of the most controversial and relevant in modern otolaryngology and neurosurgery. The key to this problem is the optimal choice of access to JNA. The article presents the results of treatment of 32 patients with JNA in the State Institution “Kolomiychenko Institute of Otolaryngology of NAMS of Ukraine. All patients underwent surgery by endoscopic endonasal approach. Selective angiography with embolization was performed only in patients with stages II and III according to Fisch classification. Patients with stage I did not receive embolization. The study protocol included CT and MRI examinations with intravenous contrast to determine the diagnosis and determine the stage of the tumor according to Fisch. Tumor recurrence was observed in 2 patients, and these patients had stage II according to Fisch. Tumor recurrence in all cases was observed in the pterygopalatine fossa area.