Juvenile Nasopharyngeal Angiofibroma: Changing Paradigms in Management

Abstract

Introduction
 Juvenile Nasopharyngeal Angiofibroma (JNA) is a tumor of young and adolescent males. It is a benign vascular tumor arising from the spheno-palatine foramen. It is best managed surgically at present by endoscopic methods with or without pre-operative embolization. Tumor attributes like intracranial extent and residual vascularity after embolization need to be assessed pre-operatively before undertaking endoscopic surgery, in order to reduce surgical blood loss and morbidity.
 Materials and Methods
 Twenty-three cases of JNA (n=23) were operated endoscopically at a tertiary level military hospital. They were staged with the Snyderman staging system. Demographic variables including stage wise management were brought out with intraoperative time and blood loss recorded for different stages.
 Results 
 The intraoperative surgical time, intra-operative blood loss and recurrence/residual rates were compared with similar studies in existing literature and correlated well.
 Conclusion
 Endoscopic Endonasal approach to JNA is now a well-established technique. With improvements in embolization techniques and better instrumentation like HD camera systems, endo-bipolar cautery, Coblation and endo-liga clips and neuro-navigation, better visualization and better haemostatis can be achieved, resulting in significant reduction in the morbidity and improvement in surgical results.