Optimization of surgical treatment of skull base juvenile angiofibroma under the conditions of scarce resources

Abstract

The authors suggest temporary ligation of external carotid artery before the excision of tumour on the lesion side in patients with juvenile angiofibroma of the skull base (JASB). Based on the suggested method, the patients were divided into two groups: group 1 – control group (n = 27) – without the preliminary temporary ligation of the external carotid artery (the traditional method) and group 2 – the main group (n = 20) – with the preliminary temporary ligation of the external carotid artery. The intraoperative blood loss in patients of the group 1 was 600.0–1500.0 ml, which, in turn, complicated the surgical view and necessitated the similar group blood and plasma transfusion. Recurrence of the disease in this group was observed in 4 patients. Bleeding during the surgery in the group 2 patients ranged from 250.0 to 550.0 ml, i.e. 2.0 and 2.5 times lower than in group 1, which provided better surgical view and did not require blood components transfusion. In this group relapse was observed in 1 patient. The comparative analysis has shown the efficacy of the proposed JASB surgical treatment method, therefore it can be used as an alternative to embolization of the external carotid artery basin, in all the regions, i.e., in the places where no high – tech equipment is available.