Juvenile Nasopharyngeal Angiofibroma

Otolaryngology - Head and Neck Surgery, 2008

International Journal of Radiation Oncology*Biology*Physics, 1989

Fifteen patients with juvenile nasopbsryngeal angiofibroms (JNA) were treated in the Department of Radiation Oncology, Baylor College of Medicine between 1973 and 1986. All patients underwent radiographic evaluation including CT scanning, selective digital subtraction angiogrsphy, tomogrsms, or MRI. Patients referred for deflnltlve irradiation exhibited extensive tumor involvement. Eleven of 15 patients bad middle cranial fossa involvement; cavernous sinus extension was observed in six patients. Ten patients were treated with primary radiation therapy; five patients had surgical resection initially and were referred for radiation therapy upon local recurrence. Followup ranges from 14-13 years. Four of the 5 patients who received 3200 cGy in 200 cGy fractions demonstrated tumor recurrence within 2 years after irradiation. All recurrences were ultimately controlled by either further irradiation and/or resection. No tumor recurrence was encountered among the patients treated at the higher tumor doses (36-46 Gy). No severe complications have been observed. Radiation therapy utiliiing carefully tailored fields is an appropriate therapeutic approach to patients with extensive disease or intracranial extension. A total dose of greater than 40 Gy may allow improved local control for advanced lesions. Juvenile nasopharyngeal angiofibroma, Intracranial extension, Radiation therapy.

INDIAN JOURNAL OF APPLIED RESEARCH, 2024

Juvenile nasopharyngeal angiofibroma is the common tumor of nasopharynx.The prognosis for this disease is extremely good if diagnosed well in time and if the tumor has not extended intracranially. Preoperative selective arterial embolization has decreased intraoperative blood loss and facilitated resection of larger tumors. Transnasal endoscopic resection preserves both the anatomy and physiology of the nose, requires less rehabilitation days after surgery,and is highly successful for selected patients. Radiation therapy is generally reserved for larger and/or unresectable tumors but has severe complications..Radio surgery has several advantages over surgery or classic radiation therapy. However, further experiences and studies are required to confirm the usefulness of radiosurgery on JNA

International journal of pediatric otorhinolaryngology, 1993

Juvenile nasopharyngeal angiofibroma is a benign, vascular tumor which typically presents in adolescent males. Although surgical resection is usually recommended for the management of this tumor, external beam radiation therapy has also been advocated in the literature. We report three cases of large juvenile nasopharyngeal angiofibromas with extensive intracranial extension primarily managed with external beam radiation therapy. Although there was not complete resolution of the tumors, there was significant alleviation of symptomatology with no serious side effects from the radiation therapy. Based on these cases, we feel that external beam radiation therapy in the management of extensive juvenile nasopharyngeal angiofibromas with intracranial extension is warranted in certain select cases.

American Journal of Otolaryngology, 2001

European Archives of Oto-Rhino-Laryngology, 2011

The management of juvenile nasopharyngeal angioWbroma (JNA) has changed during the last decades but it still continues to be a challenge for the multidisciplinary head and neck surgical team. The aim of this study was to review the used treatment approach and outcome of JNA in a single institution series of 27 patients diagnosed and treated during the years 1970-2009. All patients were male, with the median age of 17 years (range 11-33 years). Surgery was used as the primary treatment in every case. Surgical approaches varied, transpalatal approach (N = 14) being the most common approach used in this series. During the last decade various other techniques were applied, including endoscopic (N = 3) resection. Two patients were additionally treated with antiangiogenic agents and one patient with stereotactic radiotherapy. The primary recurrence rate was 37% and it seemed to correlate with vascular density of tumour and the surgical approach used. We suggest that the management of JNA should be planned by an experienced head and neck surgeon, as part of a multidisciplinary team, preferably in a tertiary referral setting, and the recent development of the available therapies should be taken into account to minimise the risk of recurrence.

Acta Neurochirurgica, 2011

Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor occurring almost exclusively in adolescent and young adult males. The tumor is characterized by slow progression, aggressive growth, high vascularization, and increased rate of persistence and recurrence. The aim of this study was to describe a case of giant JNA from our practice and discuss the controversies of surgical treatment of advanced JNA. Material and methods A series of 29 consecutive male patients with JNA Fisch grade III and IV was surgically treated in Burdenko Neurosurgical Institute from 2000 until 2008. In the vast majority of cases, endovascular embolization and surgical removal via orbitozygomatic approach were applied. Results Gross total resection was achieved in 24 cases (83%). Complications were encountered in eight cases. No mortality was observed. In three patients, the diseases recurred. An illustrative case is described. Conclusion Surgical treatment is the basic tactics in management of extensive JNA including endovascular embolization and resection of the tumor. We recommend using orbitozygomatic approach or its modifications in JNA. Radiation therapy may be recommended for patients with small residual tumor.

European Archives of Oto-Rhino-Laryngology, 2001

The aim of this retrospective study was to compare clinical and radiological findings and discuss optimal surgical approach in patients with juvenile nasopharyngeal angiofibroma (JNA). Forty-three cases of JNA were treated at our institution from 1975 to 1999. Thirty-three male patients aged between 8 and 25 years (mean 15.3) were included. Twenty-nine patients underwent primary surgical treatment at our institution and four were treated for recurrence following primary surgery elsewhere. Tumors were staged according to Fisch's staging. Preoperative embolization was performed in 22 cases. Surgical techniques consisted of the transantral approach, lateral rhinotomy approach, transmaxillary via midfacial degloving approach, and the subtemporal preauricular infratemporal fossa approach. Tumors were classified stage I in seven cases, stage II in 11, stage III in 13 and stage IV in two. The mean delay between the initial symptom and surgery was 14 months overall, 18 months for stage I, 14 for stage II, 13 for stage III and 12 for stage IV. The transantral approach was used in 11 patients, lateral rhinotomy approach in 11 cases, transmaxillary via midfacial degloving approach in three patients, and pre-auricular infra-temporal approach in eight patients. Mean follow-up after surgery was 56 months. Six patients had recurrent tumors. Surgery is the gold standard for treatment of JNA. Modern imaging techniques allow accurate diagnosis and staging of JNA. Our experience and a review of the literature shows that the surgical approach should be selected according to tumor stage.

Bengal Journal of Otolaryngology and Head Neck Surgery, 2018

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 exis...

Journal of Cranio-maxillofacial Surgery, 2006

Introduction: Juvenile nasopharyngeal angiofibromas are highly vascular, non-encapsulated tumours affecting predominantly young males. These lesions are benign histologically but they may become lifethreatening with excessive bleeding or intracranial extension. Material and methods: The surgical approaches to 22 male patients with nasopharyngeal angiofibromas are reviewed. A modification of midfacial degloving performed without rhinoplasty incisions and lateral osteotomies is described. Results: The patients' ages ranged between 9 and 26 years (mean 14.9). Three stage I tumours, 8 stage II tumours, 6 stage III tumours and 5 stage IV tumours were included into this study. All stage I lesions and one stage II lesion were treated via transnasal endoscopic approach. A modified midfacial degloving approach was used for the removal of seven other stage II lesions, all six stage III lesions, and three stage IV lesions. A combined midfacial degloving-infratemporal fossa Fisch C-transcranial approach was the route chosen for the remaining two stage IV lesions. The complications encountered in the postoperative course include temporary facial palsy in one patient (following a Fisch C infratemporal resection), mild crusting in the nasal cavity in 8 patients, and facial paraesthesia in 6 patients whose tumours were resected via midfacial degloving, and rupture of the subpetrous part of the internal carotid artery in one patient. Conclusion: The suggested treatment of juvenile nasopharyngeal angiofibroma consists of an endoscopic transnasal approach for early stage lesions, and a modified midfacial degloving for almost all of the advanced lesions. The latter approach is very useful considering surgical exposure, duration of surgery, cosmetic outcome, and morbidity. It can be combined with an infratemporal approach or craniotomy if necessary. r 2005 European Association for Cranio-Maxillofacial Surgery