Endonasal endoscopic resection of juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular; and locally invasive tumor: Because the location of these tumors makes conventional surgery difficult, interest in endoscopic resection is increasing, particularly for the treatm ent of lesions that do not ex tend laterally into the infratemporal fossa. We report the results ofour series of 23 patients with JNA (stage IlB or lower) who underwent transnasal endoscopic resection under hypoten sive general anesthesia with out preoperative embolization of the tumor. All tumors were successfully excised. The amount of intra operative blood loss was acceptable. We observed only 1 recurrence, which was diagnosed 19 months postoperatively in a patient with a stage IlB primary tumor: We observed only 3 complications during follow up all synechia. We conclude that endoscopic resection of JNAs is safe and effective. The low incidence of recurrence and complications in this series indicates that preoperative embolization may not be necessary for lesions that have not undergone extensive spread; instead, intraoperative bleeding can be adequately controlled with good hypotensive general anesthesia.

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