Objective: To present the changes of surgical approaches for the resection of juvenile nasopharyngeal angiofibromas (JNA) and the follow-up results.
Methods: The clinical records of 59 patients with JNA treated under endoscope between 2002 and 2009 were reviewed retrospectively. The patients were divided into two groups: Group A (Radkowski I a-II b) and Group B (Radkowsik II c-III b). The tumor stages, feeding vessels, operating time, complications and recurrence were observed and recorded.
Results: There were 7 patients with stage I a, 3 patients with stage I b, 5 patients with stage II a, 6 patients with stage II b, 4 patients with stage II c, 23 patients with stage III a, 11 patients with stage III b. The average age at diagnosis in Group A (21 cases) was 23.9 years old. The average operating time was (106.0 +/- 43.7) min. The follow-up ranged from 3 months to 74 months (median 36 months) except for 3 missing cases. The average age at diagnosis in Group B (38 cases) was 16.2 years old and the average operating time was (152.9 +/- 58.0) min. The follow-up ranged from 3 months to 87 months (median 25 months) except for 5 missing cases. During follow-up, 6 patients in group B recurred. Infarction of thalamencephalon happened in 1 patient in group B who recovered totally afterwards. The difference in operating time between two groups was statistically significant (t = -3.232, P = 0.002). The life table was used to evaluate the survival curves and Log-rank test showed that the difference of recurrent time between two groups was statistically significant (P = 0.03).
Conclusions: The key techniques to remove tumor are bleeding control, drilling-out the bone that tumor invaded. Transpterygoid or posterolateral wall of maxillary sinus approach are recommended for tumors that extend to infratemporal fossa. Small and intermediate-sized JNA which have no deep invasion of skull base (RadkowskiIa-II b) have a low morbidity. JNA at Radkowski stage IIc and above have residual and recurrent risk.