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

Khoueir, Nadim; Nicolas, Nicolas; Rohayem, Ziad; Haddad, A.; Hamad, Walid M. Abou

doi:10.1177/0194599813516605

Cited by 41 publications

(8 citation statements)

References 91 publications

(190 reference statements)

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“…in 1996 is the most widely accepted classification. [21024] Approximately a decade later, Onerci et al . developed another updated classification in 2006, which was based on advances made in imaging technology and the expanded use of endoscopes.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas

Janakiram¹,

Sharma²,

Kasper³

et al. 2017

Surg Neurol Int

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Background:Juvenile nasal angiofibromas (JNA) is a benign lesion with high vascularity and propensity of bone erosion leading to skull base invasion and intracranial extension. It is known to involve multiple compartments, which are often surgically difficult to access. With evolution in surgical expertise and technical innovations, endoscopic and endoscopic-assisted management has become the preferred choice of surgical management. Over the last four decades, various staging systems have been proposed, which are largely based on the extent of nasal angiofibroma. However, no clear guidelines exist for the stage-appropriate surgical management. In this study, we aim to formulate a novel staging system based on the analysis of high quality preoperative imaging and propose detailed surgical guidelines related to disease stages as observed in 242 primary cases of JNA.Methods:A retrospective analysis of the case records of 242 primary JNA cases was performed at our center. Patients were staged according to various existing staging systems as well as our own new staging system, and outcome variables were compared with respect to intraoperative blood loss, multiple staged operations, and tumor recurrences. Operative records were studied and precise endoscopic surgical guidelines were formulated for each stage.Results:Comparing the intraoperative blood loss seen in stages of various classifications, it was found that intraoperative blood loss correlated best and statistically significantly with stages in the newly proposed Janakiram staging system when compared to the existing staging systems. Staged operations were performed in a total of 7/242 patients, and there was a significant association between the requirement of a staged operation and tumor extent (Fischer's exact test, P < 0.001). Tumor recurrence was seen in 22 cases and the pterygoid wedge was found to be the most frequent site of recurrence initially. As the extent of resection improved with better surgical technique over time, recurrences were only found in superior orbital fissure, around the internal carotid artery, and in the middle cranial fossa.Conclusion:This new Janakiram staging system is based on preoperative imaging data from one of the largest JNA case series reported thus far. Respective guidelines reliably stratify patients into treatment groups with definite surgical approaches and predicts outcome. Improved surgical approaches in the modern endoscopic era have redefined JNA management with improved outcome. This study shows the importance of precise presurgical imaging and the choice of the most suitable surgical approach in reducing morbidity and mortality in JNA surgery.

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Section: Discussionmentioning

confidence: 99%

Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas

Janakiram¹,

Sharma²,

Kasper³

et al. 2017

Surg Neurol Int

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“…Currently, the surgical removal is the therapy of choice. The endonasal endoscopic approach is meanwhile considered as approach of choice for most patients [ 1039 ] especially in case of smaller tumors and extension into the infratemporal fossa, orbit, parasellar region [ 1040 ]. Specialized centers report on complete resection of advanced and intracranial tumors [ 1040 ], [ 1041 ].…”

Section: Indications Of Surgery Beyond Chronic Rhinosinusitismentioning

confidence: 99%

“…A systematic review of the literature in order to compare exclusively endoscopic, endoscopically assisted or open resection of JNA revealed the lowest recurrence rate and the lowest blood loss for the exclusively endoscopic approach [ 1043 ]. The recurrence rate amounts to around 10% [ 1039 ].…”

Section: Indications Of Surgery Beyond Chronic Rhinosinusitismentioning

confidence: 99%

“… Sense and necessity of preoperative embolization are discussed controversially [ 1044 ]. A recent meta-analysis on endoscopic therapy of JNA revealed a minimal blood loss when embolization is applied, however, because of missing prospective comparative studies a clear recommendation could not be given [ 1039 ]. Important surgical measures are the reduction of intraoperative bleeding by targeted early occlusion of afferent vessels and the reduction of the tumor by means of coagulating devices or laser systems in order to minimize substantial bleeding from vessels near the surface [ 1044 ].…”

Section: Indications Of Surgery Beyond Chronic Rhinosinusitismentioning

confidence: 99%

Section: Indications Of Surgery Beyond Chronic Rhinosinusitismentioning

confidence: 99%

See 2 more Smart Citations

Comprehensive review on endonasal endoscopic sinus surgery

Weber¹,

Hosemann

2015

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 14:Doc08

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Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single‐stage rhinosurgical and neurosurgical approach

Naraghi

Saberi

Mirmohseni

et al. 2015

Int Forum Allergy Rhinol

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Management of intracranial intradural JNA requires a multidisciplinary approach of combined open and endoscopic-assisted rhinosurgery and neurosurgery, because of greater risk for complications during the dissection. Carotid rupture and brain damage remain 2 catastrophic complications that should always be kept in mind. A combined rhinosurgical and neurosurgical approach also has the advantage of very modest cosmetic complications.

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

Abstract: 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.

Cited by 41 publications

References 91 publications

Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas

Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas

Comprehensive review on endonasal endoscopic sinus surgery

Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single‐stage rhinosurgical and neurosurgical approach

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