Management Of Juvenile Angiofibroma Research Articles

Treatment of juvenile angiofibromas: 18-year experience of a single tertiary centre in Spain

The management of juvenile angiofibroma (JA) has changed during the last decades but it still continues to be a challenge. The objective of this study was to review the used treatment and our outcomes. From 1992 to 2010, 48 cases of JA were treated at our department. Charts were reviewed for standard demographic, tumour size and location, vascular supply and results of embolization, surgical approach, operative results, adjuvant therapies, recurrence and postoperative follow-up. Most tumours were Andrews-Fisch stages III and IV and surgery was used as the main treatment in all cases. We used an open surgical approach in 37 (77%) patients and 11 (23%) were treated endoscopically. The most common open approach used in this series was the subtemporal-preauricular approach. Until 1995, all tumours were operated on by a conventional open approach. Afterwards, early-stage tumours were operated on through an endoscopic approach. Ten patients were treated through surgery followed by radiosurgery. Two (4%) patients had recurrent disease. These tumours should be treated at centres with expertise in skull base surgery to achieve complete surgical resections with low morbidity. Radiosurgery after surgery seems to be a valuable option in the long-term control of some extended JAs.

Treatment of juvenile angiofibromas: 18-year experience of a single tertiary centre in Spain

Background: The management of juvenile angiofibroma (JA) has changed during the last decades but it still continues to be a challenge. The objective of this study was to review the used treatment and our outcomes. Methods: From 1992 to 2010, 48 cases of JA were treated at our department. Charts were reviewed for standard demographic, tumour size and location, vascular supply and results of embolization, surgical approach, operative results, adjuvant therapies, recurrence and postoperative follow-up. Results: Most tumours were Andrews-Fisch stages III and IV and surgery was used as the main treatment in all cases. We used an open surgical approach in 37 (77%) patients and 11 (23%) were treated endoscopically. The most common open approach used in this series was the subtemporal-preauricular approach. Until 1995, all tumours were operated on by a conventional open approach. Afterwards, early-stage tumours were operated on through an endoscopic approach. Ten patients were treated through surgery followed by radiosurgery. Two (4%) patients had recurrent disease. Conclusions: These tumours should be treated at centres with expertise in skull base surgery to achieve complete surgical resections with low morbidity. Radiosurgery after surgery seems to be a valuable option in the long-term control of some extended JAs.

Juvenile Angiofibroma: Evolution of Management

Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent epistaxis and nasal obstruction. Although the use of nonsurgical therapies is described in the literature, surgery is currently considered the ideal treatment for juvenile angiofibroma. Refinement in preoperative embolization has provided significant reduction of complications and intraoperative bleeding with minimal risk of residual disease. During the last decade, an endoscopic technique has been extensively adopted as a valid alternative to external approaches in the management of small-intermediate size juvenile angiofibromas. Herein, we review the evolution in the management of juvenile angiofibroma with particular reference to recent advances in diagnosis and treatment.

Endoscopic Surgery for Juvenile Angiofibroma: A Critical Review of Indications after 46 Cases

At present, transnasal endoscopic surgery is considered a viable option in the management of small-intermediate size juvenile angiofibromas (JAs). The authors critically review their 14-year experience in the management of this lesion to refine selection criteria for an endoscopic approach. From January 1994 to May 2008, 46 patients were treated by a pure endoscopic resection after vascular embolization (87%). The lesions were classified according to Andrews (Andrews JC, et al., The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach, Laryngoscope 99:429-437, 1989) and Onerci (Onerci M, et al. Juvenile nasopharyngeal angiofibroma: A revised staging system, Rhinology 44:39-45, 2006) staging systems. All patients were followed by regular endoscopic and magnetic resonance imaging (MRI) examinations. Lesions were classified as follows: stage I, n = 5; stage II, n = 24; stage IIIa, n = 14; stage IIIb, n = 3 according to Andrews classification system; stage 1, n = 9; stage II, n = 12; stage III, n = 26 according to Onerci's system. Unilateral blood supply was detected in 39 (85%) cases. Feeding vessels from the internal carotid artery (ICA) were also reported in 14 (30%) patients. Intraoperative blood loss ranged from 250 to 1300 mL (mean, 580 mL). In four (8.7%) cases, suspicious residual disease was detected by MRI. In one patient, a 1-cm persistent lesion was endoscopically removed because septoplasty was required and a slight increase in size was noticed. The other three lesions, all located in the root of the pterygoid plate, are nearly stable in size and are currently under MRI follow-up. The improvement of surgical instrumentation and the experience acquired during a 14-year period have contributed to expanding the indications for endoscopic surgery in the management of JAs. Even stage III lesions may be successfully managed, unless the ICA is encased or if it provides an extensive blood supply. An external approach may be required when critical structures such as the ICA, cavernous sinus, or optic nerve are involved by lesions that are persistent after previous treatment; such a situation may prevent safe and radical dissection with a pure endoscopic approach. Better understanding of the factors influencing the growth of residual lesions is needed to differentiate those requiring re-treatment from those which can be simply observed.

Management of juvenile angiofibroma via midfacial degloving with medial maxillectomy

Medial maxillectomy provides excellent exposure through which a juvenile angiofibroma tumor can be removed. Medial maxillectomy is usually performed through a lateral rhinotomy type of incision. In this article, we describe the combination of the wide exposure provided by medial maxillectomy with the midfacial degloving approach that avoids the need for facial skin incisions.

上咽頭血管線維腫の放射線・ホルモン併用療法

We describe a 15-year-old boy, who presented with recurrent nasal bleeding. A diagnosis of nasopharyngeal angiofibroma (stage I) was made and, the tumor was excised by a transpalatal approach. Four months later, we found a recurrent tumor. Two months later, CT scan and NMR imaging revealed that it had extended into the temporal fossa and intracranially (stage IV). We thought conservative therapy would be much safer and more appropriate than surgery, hence he was treated with combinded irradiation (3000 rad) and hormone (estrogen) therapy. The tumor was completely eradicated in 2 years. The place of surgical and radiotherapy in the management of juvenile angiofibroma is discussed.

Juvenile angiofibroma: a more rational therapeutic approach based upon clinical and experimental evidence.

AbstractA new and more rational therapeutic approach to the diagnosis and management of juvenile angiofibromas was formulated based upon the experiences in 35 cases.Preoperative angiography is essential in delineating the mass, and demonstrating extension into surrounding areas, and for delineation of the sources of blood supply to the tumor. Arteriography has shown 20 percent of the cases to have middle fossa extension, and that the size of the tumor in the nasopharynx does not necessarily represent the size and extent of the tumor and may be only the “tip of the iceberg.”The death of a patient with intracranial extension. The cessation of bleeding, and shrinkage of the tumor was demonstrated by pre and post therapy arteriography and scanning. Because of the success of the transpalatal surgical approach and the hesitancy of administering irradiation too, surgical excision is the treatment of choice in all cases that do not have intracranial extension.