Treatment Of Juvenile Nasopharyngeal Angiofibroma Research Articles

Total Endoscopic or Endoscope-Assisted Excision of Non-embolized Advanced Juvenile Nasopharyngeal Angiofibroma: A Clinical Case Series.

Background Surgical excision is the primary treatment for juvenile nasopharyngeal angiofibroma (JNA), but this procedure is challenging due to its high vascularity and local aggressiveness. Moreover, preoperative embolization is a subject of debate. Objective The objective of this study is to assess the efficacy, safety, and feasibility of endoscope-assisted excision as a surgical intervention for non-embolized advanced JNA. Materials and methods This case series involved six male patients (mean age: 16 years) with JNA, classified as stages Ⅱc to Ⅲb according to the Radkowski classification. None underwent preoperative embolization. Results Two stage Ⅱc cases underwent total endoscopic endonasal excision. One patient with stage Ⅲa and another with stage Ⅲb underwent surgery via an endoscope-assisted sublabial approach. Two patients, one with stage Ⅱc JNA and another with Ⅲb, underwent a two-stage procedure. Postoperative CT scans showed no residual disease at the six-month mark. On average, each procedure required 1.5 units of blood transfusion. One patient experienced intraoperative bleeding, whereas the remaining patients were free of any major complications. The mean operation duration was 175 minutes per procedure. The mean length of stay at the hospital was 3.75 days per procedure. Conclusion Endoscope-assisted or purely endoscopic approaches can be safely and effectively employed for the complete excision of non-embolized advanced JNAs.

History and modern aspects of treatment of juvenile nasopharyngeal angiofibroma

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.

Pharmacoeconomic research of surgical treatment of juvenile nasopharyngeal angiofibroma: preoperative endovascularly occlusion classes

Introduction. Intraoperative control of bleeding during surgical treatment of juvenile nasopharyngeal angiofibroma (JAN) remains controversial. There is no consensus as to the routine use of preoperative embolization, given its high cost and inconsistent availability of the procedure in care centers. There were no publications devoted to the comprehensive pharmacoeconomic analysis of preoperative vascular embolization (PVE) occlusion classes on the surgical treatment of JAN by the time of publication Aim. To evaluate pharmacoeconomic value of preoperative vascular embolization (PVE) occlusion classes (non-embolized, incomplete and complete) on the surgical treatment of JAN.Materials and methods. A total of 139 patients who underwent JNA surgical resection in 2013-2021 time period were identified. All of these patients were treated in National Medical Research Center for Children's Hematology, Oncology and Immunology named after Dmitry Rogachev. We evaluated JNA surgical resection outcomes, length of stay (LOS) with prognostic factors using a multiple linear regression (MLR), cost-per-day (CPD), cost-minimization analysis (CMA), cost-utility ratio (CUR), willingness to pay (WTP) with purchasing power parity (PWP).Results and discusion. Surgical transnasal endoscopic treatment of JAN in the quaternary healthcare center, regardless of the degree of embolization and the presence/absence of intraoperative blood transfusion, is at the willingness-to-pay threshold for the healthcare system of the Russian Federation. The most cost-utility method of treatment remains the absence of embolization (within clips placed in the larger diameter vessels). and the absence of blood transfusion, the least cost-utility method is the incomplete embolization, regardless of the presence/absence of blood transfusion.Conclusion. The results of the pharmacoeconomic study emphasize the high significance of the rejection of routine preoperative vascular embolization of JAN and implementation of standard risk-adapted treatment algorithm for indications of preoperative vascular embolization. Which is particularly important for resource allocations and health policy decision making to increase the efficacy and safety of the JNA treatment.

The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

Juvenile nasopharyngeal angiofibroma (JNA) is a rare but potentially life-threatening fibrovascular tumor that is seen almost exclusively in adolescent males and usually presents with symptoms of nasal obstruction or severe epistaxis. The current gold standard of treatment consists of complete surgical resection; however, this is inherently challenging because of the tumor's invasive nature and a substantial risk of intraoperative hemorrhage. Flutamide, an anti-androgen antineoplastic agent, has been used preoperatively in attempts to reduce tumor volume allowing for surgical resection with more conservative procedural techniques and reduce intraoperative blood loss. A literature review of PubMed and CINAHL was used to identify and analyze 29 male patients with JNA to determine the efficacy of the preoperative use of flutamide. Our analyses indicate that flutamide may be effective as a neoadjuvant agent by reducing tumor volume prior to resection in some patients but seemed to be more effective in the early stages of JNA without advanced tumor invasion. However, individual tumor response to flutamide was variable. Additionally, postpubertal patients seemed to demonstrate a greater reduction in tumor volume with flutamide compared to their prepubertal counterparts. Dosing regimen and side effects associated with flutamide therapy are also discussed. Flutamide may be an effective neoadjuvant therapy in some cases of juvenile nasopharyngeal angiofibroma, but larger scale, case-control studies are likely needed to further expand on this conclusion. Postpubertal males with early-stage disease seemed to be the population that may benefit most from this treatment protocol.

CT scan pitfalls and angiography’s role in juvenile nasopharyngeal angiofibroma: A case report

Diagnosis to treatment of Juvenile Nasopharyngeal Angiofibroma (JNA) required a multidisciplinary approach. CT scan works by combining multi-slice imaging from a device that rotates around the object. The potential of missing certain parts in the scanning process can occur. Angiography was the option to cover the CT scan pitfalls. In this case, we discussed CT scan pitfalls that can be overcome by angiography through JNA case report by showing clearer picture of the JNA and its feeding artery. 14 years old child complained of nasal congestion. On physical examination, the lesion expanded the anterior side of nasal cavity. The patient underwent a synonasal CT scan without contrast. It was obtained a heterogeneous solid mass in the nasopharynx extending to the concha and right and left maxillary sinuses. However, until the preparation of angiography, the actual size of the tumor, as well as the entire vasculature, is not yet known. The angiographic features suggested that the right side (seen in the right maxillary artery) was more dominant than the left side. However, both the right and the left finding reassured that the tumor location was more dominant in the anterior nasal cavity. The posterior lesion was also seen but did not predominate in comparison to the anterior. These findings helped clinicians in planning operative action in order to evacuate the tumor.

Current Management of Juvenile Nasopharyngeal Angiofibroma

The purpose of this article is to provide a current review of the most important management principles for evaluation and treatment of juvenile nasopharyngeal angiofibroma. Numerical staging systems have been adapted many times over the years, but a new nominal staging system based on specific anatomical site involvement and residual internal carotid artery vascularization helps to provide a more comprehensive alternative for evaluation. An expanding body of evidence supports the use of an endoscopic surgical approach to reduce risk of tumor recurrence and reduce intraoperative blood loss. With minimally invasive, endoscopic techniques available, the primary treatment modality for JNA remains surgery. However, gamma knife radiosurgery can be useful in a multimodality approach to more advanced cases of JNA and to address recurrence in the immediate postoperative period. This review focuses on the evaluation and surgical management of juvenile nasopharyngeal angiofibroma with emphasis placed on the most current staging systems, the necessity for preoperative embolization, the endoscopic approach to resection, and the adjuvant therapies that are available.

A safer endovascular technique for pre-operative embolization of juvenile nasopharyngeal angiofibroma: avoiding the pitfalls of external carotid artery - internal carotid artery anastomoses.

Intra-arterial embolization of juvenile nasopharyngeal angiofibroma (JNA) prior to surgical resection is the preferred approach to minimize blood loss during surgical resection of the tumor. However, the presence of external carotid artery–internal carotid artery (ECA-ICA) anastomoses may hinder complete tumor embolization due to the associated risk for embolic complications. Here, we evaluate the use of a balloon-assisted embolization (BAE) technique in the treatment of JNA. We conducted a retrospective review of JNA patients who underwent tumor embolization with injection of Onyx in a single session between 2013–2018. All cases displayed tumor arterial supply from ECA and ICA circulations on 2-D catheter angiograms. Procedural and surgical outcome data were analyzed. Results are given as mean±standard deviation (range). Among 9 patients with JNA, all were males and mean age was 14.1±6.3 years (range, 9–29 years). The mean tumor volume embolization was 84.4±12.4% (range, 60–100%) and in 89% patients ≥80% of tumor volume embolization was achieved. There were no embolization-related complications reported. During surgical resection of the tumor there was a low average surgical blood loss of 722±651.5 mL (range, 50–2,000 mL) and the mean procedure time was 282.6±85.4 mins (range, 151–403 mins). In this series, the BAE technique showed to be a safe and effective approach to achieve successful tumor embolization while avoiding embolic complications and effectively reducing the risk for blood loss during surgical resection.

Experience in the surgical treatment of juvenile nasopharyngeal angiofibroma at the Hospital de Especialidades No. 2 “Lic. Luis Donaldo Colosio Murrieta”, Mexican Social Security Institute, Ciudad Obregón, Sonora

Objetivo: Exponer nuestra experiencia y evaluar la recurrencia en el manejo quirurgico del angiofibroma nasal juvenil, abordaje abierto contra endoscopico, en el servicio de otorrinolaringologia del noroeste del pais. Materiales y metodos: Estudio observacional, retrospectivo, analitico. Se revisaron los expedientes clinicos de los pacientes con diagnostico de angiofibroma nasal juvenil de 2014 a 2017, atendidos en el Servicio de Otorrinolaringologia y Cirugia de Cabeza y Cuello de esta institucion. Resultados: Un total de 19 pacientes con diagnostico de angiofibroma nasal juvenil, fueron sometidos a un procedimiento quirurgico, 14 abiertos y 5 endoscopicos, la recurrencia fue de 50 % y 40 % respectivamente, lo cual no fue estadisticamente significativo (p=0.88). No obstante, se contrastaron otras variables, como la necesidad de la Unidad de Cuidados Intensivos (UCI) para ambos grupos, 71 % en abordaje abierto y 20 % para el endoscopico, en lo cual si encontramos diferencia significativa (p=0.04). Conclusiones: El estudio no muestra una ventaja estadisticamente significativa del abordaje endoscopico frente al abordaje abierto, pero si una menor necesidad de hospitalizacion en UCI, lo que reduciria los costos de atencion.

Inhibition of fibroblast growth factor receptor with AZD4547 mitigates juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor that presents in adolescent males. Although surgical excision is the mainstay of treatment, recurrences complicate treatment. There is a need to develop less invasive approaches for management. JNA tumors are composed of fibroblasts and vascular endothelial cells. We identified fibroblast growth factor receptor (FGFR) and vascular endothelial growth factor (VEGF) expression in JNA-derived fibroblasts. FGFR influences fibroblast proliferation and VEGF is necessary for angiogenesis. We hypothesized that targeting FGFR would mitigate JNA fibroblast proliferation, invasion, and migration, and that targeting the VEGF receptor would attenuate endothelial tubule formation. After informed consent, fibroblasts from JNA explants of 3 patients were isolated. Fibroblasts were treated with FGFR inhibitor AZD4547, 0 to 25 μg/mL for 72 hours and proliferation was quantified using CyQuant assay. Migration and invasion of JNA were assessed using 24-hour transwell assays with subsequent fixation and quantification. Mitigation of FGFR and downstream signaling was evaluated by immunoblotting. Tubule formation was assessed in human umbilical vein endothelial cells (HUVECs) treated with vehicle control (dimethylsulfoxide [DMSO]) or semaxanib (SU5416) as well as in serum-free media (SFM) or JNA conditioned media (CM). Tubule length was compared between treatment groups. Compared to control, AZD4547 inhibited JNA fibroblast proliferation, migration, and invasion through inhibition of FGFR and downstream signaling, specifically phosphorylation of - p44/42 mitogen activated protein kinase (p44/42 MAPK). JNA fibroblast CM significantly increased HUVEC tubule formation (p = 0.0039). AZD4547 effectively mitigates FGFR signaling and decreases JNA fibroblast proliferation, migration, and invasion. SU5416 attenuated JNA fibroblast-induced tubule formation. AZD4547 may have therapeutic potential in the treatment of JNA.

Conformal radiotherapy for locally advanced juvenile nasopharyngeal angio-fibroma.

To assess the efficacy of radiation in the treatment of juvenile nasopharyngeal angiofibroma (JNA). Data were retrieved for JNA treated with radiotherapy from 1987-2012. The demographics, treatment and outcome data were recorded in predesigned proforma. Data of 32 patients were retrieved. Median age was 17 years (range: 12-33 years). All patients received radiation because of refractory, residual or unresectable locally advanced disease. All patients were planned with a three-dimensional conformal technique (3DCRT). The median radiation dose was 30 Gray (range: 30-45 Gray). Median follow-up was 129 months (range: 1-276 months). At the last follow-up, 13 patients were found to have a radiological complete response. Two patients progressed 38 and 43 months after completion of treatment and opted for alternative treatment. One patient developed squamous cell carcinoma of the nasal ale 15 years after radiation. Conformal radiotherapy shows promise as an alternative treatment approach for locally advanced JNA and confers long-term disease control with minimal toxicity.

Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature

Objectives: Systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature in order to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications. Methods: Literature was searched by 2 reviewers in online databases including PubMed and Embase with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. Reference sections of identified studies were examined for additional articles. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models. Results: Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (Min = 20 mL; Max = 1482 mL). It was 414.6 mL (Min = 20 mL; Max = 1000 mL) and 774.2 mL (Min = 228 mL; Max = 1482 mL) respectively in the group with and without embolization. No conclusion could be taken because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval, 0.083-0.117). It was 9.3% (95% confidence interval, 0.072-0.115) for complications and 7.7% (95% confidence interval, 0.054-0.101) for residual tumor. Conclusions: Endoscopic treatment is an evolving modality. It is considered today as the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.

Complications in the endoscopic and endoscopic-assisted treatment of juvenile nasopharyngeal angiofibroma with intracranial extension ,

IntroductionAlthough it is a rare neoplasm, juvenile nasopharyngeal angiofibroma (JNA) is associated with high rates of morbidity and mortality, with the potential for intracranial extension. Surgical excision is the main treatment. The external approach has largely been replaced by the endoscopic approach in small lesions, and it can be used as a complement in more advanced cases. However, there is no consensus in the literature regarding the complications of surgical treatment of JNAs with intracranial extension. AimTo assess the prevalence of complications in endoscopic or endoscopic-assisted surgical treatment of JNA with minimal intracranial invasion. MethodsThis was a retrospective cohort study of all patients with JNA with intracranial extension (Radkowski grade IIIa) treated with endoscopic, endoscopic-assisted, and external surgery from January of 1996 to May of 2010. ResultsThirteen patients underwent surgery. Endoscopic surgery was performed in three patients, without postoperative complications; endoscopic-assisted surgery in three others, with two instances of complications, and external surgery in seven. ConclusionsOperative treatment of nasopharyngeal angiofibroma with intracranial extension is one of the major challenges of ENT and neurosurgical practice. The success rates and low intra- and postoperative complication rates of endoscopic surgery suggest that this route has been gaining ground in the management of Radkowski grade IIIa JNAs.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature

To systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications. Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. The literature was searched by 2 reviewers with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models. Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (minimum, 20 mL; maximum, 1482 mL). It was 414.6 mL (minimum, 20 mL; maximum, 1000 mL) and 774.2 mL (minimum, 228 mL; maximum, 1482 mL), respectively, in the group with and without embolization. No conclusion could be made because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval [CI], 8.3-11.7). It was 9.3% (95% CI, 7.2-11.5) for complications and 7.7% (95% CI, 5.4-10.1) for residual tumor. The endoscopic treatment is an evolving modality. It is considered today the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.

Coblation assisted endoscopic juvenile nasopharyngeal angiofibroma resection

To provide additional support for the use of coblation in the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) tumors. Coblation radiofrequency has been recently described in endoscopic sinus surgery for polyp and tumor resection from the sinuses to the skull base. This is a case series from our institution in which we safely and successfully treated three adolescent boys with JNA using the coblation assisted technique. The first case was the smallest of the cases (Radkowski stage IB) and was embolized pre-operatively. The second and third cases, both larger in size (Radkowski stage IIC and IIB) did not undergo pre-operative embolization. The total surgical times were 105, 160, and 150min and the estimated blood losses were 150, 400, and 130mL, respectively. This yielded a blood loss per minute rate of only 1.4, 2.5, and 0.9mL/min for the respective cases. None of the three patients required post-operative blood transfusion, nasal packing, or hospitalization of greater than one day. Follow-up showed no complications and no recurrence in these patients. Coblation assisted transnasal endoscopic resection of JNA is a feasible technique that can dissect through and debulk JNA tumor, despite its extreme vascularity. The surgery can be performed with minimal morbidity and low intraoperative blood loss, even with non-embolized tumors up to Radkowski IIC. These finding further support complete resection of JNA tumors using minimally invasive coblation assisted techniques.

Diagnosis and Treatment of Juvenile Nasopharyngeal Angiofibroma: Impressions from a University Hospital

Objective: Describe the characteristics of diagnosis and treatment of JNA at a teaching hospital. Method: A retrospective cross-sectional study was conducted by revision of medical records from patients treated for juvenile nasopharyngeal angiofibroma between January 2007 and October 2010. Results: There were 11 patients, all males, with mean age of 15.18 years, who underwent surgery. Nasal obstruction was the initial symptom (54.55%), followed by epistaxis (45.45%). Stage II of Andrews was most commonly observed (54.55%). Preoperative embolization was performed in 45.45% of patients, and the most common approach was endoscopic-assisted mid-facial degloving (72.73%). Intraoperative blood transfusion was necessary in 72.73%, due to decrease in hemoglobin average from 13.18 to 8.54 g/dL. ICU hospitalization average was 2.78 days, and hospital discharge average was 8.18 days. Recurrence occurred in 2 cases, totaling 18.18% of failure. Preoperative embolization and use of endoscope reduced risk of relapser=0.77 (Pearson correlation). Conclusion: We described our experience and found that preoperative embolization and use of endoscope reduced risk of relapse.

Juvenile Nasophryngeal Angiofibroma,New Aspects in Management

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign and locally invasive tumor. Massive bleeding because of vascularity of tumor and postoperative recurrence are potential problems of management. Endonasal approach reduces the rate of postoperative recurrence, intraoperative bleeding, and complications of surgery, time of operation and duration of hospitalization. In this article, we review the indications and contraindications of endoscopic surgery, indications of radiotherapy in treatment of JNA and our policy in postoperative follow-up and management of patients.

Radiotherapy for juvenile nasopharyngeal angiofibroma

PurposeTo explain the concepts that radiation oncologists need to understand to manage patients with juvenile nasopharyngeal angiofibroma (JNA). To accomplish this goal we first describe our institution's experience with radiotherapy for JNA and then use this data set as a framework for explaining the role of radiotherapy in the treatment of this uncommon tumor. Methods and MaterialsWe studied the outcomes of all 24 patients treated with radiotherapy for JNA at our institution. All patients had at least 4 years of follow-up (median follow-up, 18 years). The standard dose in the first half of the series was 30 Gy in 22 treatments (1.43 Gy/treatment). After observing recurrences with this schedule, the prescription was changed to 35 to 36 Gy at 1.8 Gy/treatment. In all cases, the target volume was the primary site without an attempt to cover the regional nodes. ResultsAll recurrences were at the primary site and presented within 5 years of completing radiotherapy. There appeared to be a dose response for tumor control: 77% with 30 to 32 Gy versus 91% with 35 to 36 Gy. All recurrences following radiotherapy were successfully salvaged with surgery. The only complications from radiotherapy were cataracts in 2 patients. No patient had a significant growth abnormality or second tumor. ConclusionsSurgery is the best treatment for JNA when cure is likely with low morbidity, but the threshold for using radiotherapy should be low because moderate-dose radiotherapy cures about 90% of patients with a low risk of serious complications. We recommend 36 Gy at 1.8 Gy per treatment in most cases. Elective nodal irradiation is not necessary. Radiographic response should be almost complete within a year of radiotherapy. Patients should be followed with cross-sectional imaging every 6 months for at least 5 years.

Juvenile Nasopharyngeal Angiofibroma with Intracranial Extension

To provide a critical evaluation of the historical evolution of the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) with intracranial extension. Case series with chart review. Skull base multidisciplinary group at the Instituto de Neurologia de Curitiba, Brazil. From 1988 to 2000, the multidisciplinary skull base group surgically treated 67 adolescent boys with JNA, 20 of whom presented with intracranial extension. All patients presented involvement of the cavernous sinus, and 5 of them spread into the orbit. Before 2008, the authors combined microscopic-endoscopic techniques. After this period, the surgical approach used was facial degloving, associated with purely endoscopic technique patients. Total tumor removal was achieved in 17 cases in the first surgery. In this series, the intracranial extension was extradural in all cases. There was only 1 case of cerebrospinal fluid leakage, which was promptly identified and treated. There was no mortality or permanent morbidity. Radical removal of large JNA may be difficult because of its extreme vascularity and extension to the cavernous sinus, orbit, middle and anterior fossa. Nevertheless, most of JNA with intracranial extension can be resected in the first operation with minimal morbidity through a facial degloving and further combination of expanded endoscopic endonasal approaches.

Lefort I access for Juvenile Nasopharyngeal Angiofibroma (JNA): A prospective series of 22 cases

Introduction The mainstay treatment for Juvenile Nasopharyngeal Angiofibroma (JNA) is complete excision. Surgical approach should allow maximal exposure of the tumour with minimum morbidity. One such possible approach is Lefort I maxillary osteotomy. Objective To review our experience on feasibility of Lefort I osteotomy approach to achieve the best result and to look at the outcome in our series of patients at a tertiary centre in India. Method This prospective study involves 22 patients with JNA who have been treated by Lefort I approach between August 2006 and December 2007 at the Department of Neurosurgery, National Institute of Mental Health And Neurosciences, Bangalore, India. Results All patients underwent primary surgical resection through Lefort I approach. No major intra-operative and post-operative complications were noted except in one patient where loss of vision in one eye due to prior pre-operative orbital involvement. The mean follow-up period was 2.8 years. To date, there has been no cases of residual tumour or recurrence that can be attributed to the procedure except in one case. Conclusion Our experience suggests that the Lefort I osteotomy approach is a useful technique for the removal of extensive JNA which has distinct advantages over traditional approaches, providing a more direct vision, improved exposure, and cosmesis.

Intratumorale Onyx®-Embolisation in der Therapie von juvenilen Nasenrachenangiofibromen

Preoperative embolization for the treatment of juvenile nasopharyngeal angiofibroma was successfully accomplished with Onyx by intratumoral puncture for the first time. Extratumoral migration of Onyx particles was not observed, precluding the necessity to inflate the shield balloon. Postinterventional angiography showed complete occlusion of all supporting blood vessels. Transnasal surgery on the following day achieved complete resection of the angiofibroma without complications. Direct intratumoral embolization of juvenile nasopharyngeal angiofibromas appears to be a safe and effective preoperative method without complications. It could represent a new strategy for the treatment of JNA, as is already the case with other highly vascularized head and neck tumors. Moreover, it increases the likelihood of achieving complete resection.