Juvenile Angiofibroma: What Is on Stage?

Abstract

Objectives/Hypothesis: The aim of the present study is to validate and compare four of the most widely used staging systems for juvenile angiofibroma on a homogeneous cohort of patients.Study Design: Retrospective case series. Methods: A retrospective review of patients treated with endoscopic or endoscopic-assisted surgical resection between 1999 and 2020 was carried out. Each case was classified according to the following staging systems: Andrews-Fisch (1989), Radkowski (1996), University of Pittsburgh Medical Center (2010), and Janakiram (2017). Spearman's rank correlation test and areas under the curve of receiver operator curves were used to assess the correlation between outcomes of interests (blood loss, surgical time, need for transfusion, and persistence of disease) and stage of disease.Results: Seventy-nine patients were included, with a median follow-up time of 25 months (range 12-127 months). Median surgical time was 217 minutes (range 52-625). Median blood loss was 500 mL (range 40-5200) and 27 patients (34.2%) required blood transfusions. Seven patients (8.9%) showed persistence of disease. All classification systems showed a similar association with blood loss, surgical time, persistence of disease, and need for transfusion.Conclusions: Involvement of the infratemporal fossa and intracranial extension was identified as red flags for surgical planning and preoperative counseling, as associated with increased risk for transfusion and persistent/recurrent disease, respectively. No classification system was found to be better than the others in predicting the most important outcomes. Therefore, the simplest and most easily applicable system would be the preferred one to be used in clinical practice.

Juvenile Nasopharyngeal Angiofibroma: Outcomes Analysis Based Upon Hospital Volume

“…The rates of recurrence in the literature vary from 0% to 24% for single institution case series. 10,12,13,[15][16][17][18] Overall, 43 (15.0%) patients required surgical revision in this PHIS JNA cohort, in line with the published literature. There was, however, a significant difference in surgical revision rates between high (7.4%) and low-volume (20%) hospitals, supporting the hypothesis that operative and perioperative team experience, as reflected by surgical volume, corresponds to more definitive resection and decreased recidivism rates.…”

“…Residual disease with the need for surgical revision is one of the greatest risks of JNA surgery. The rates of recurrence in the literature vary from 0% to 24% for single institution case series 10,12,13,15–18 . Overall, 43 (15.0%) patients required surgical revision in this PHIS JNA cohort, in line with the published literature.…”

Comparison of External Carotid Ligation and Preope Embolization of Feeding Vessel for Controlling Perop Heamorhage in Angiofibroma Excision

“…The origin of juvenile angiofibroma is from the lateral aspect of the nasopharynx just above the opening of sphenopalatine foramen 12 . The staging of angiofibroma is made on the scale of Fisch 9 , which determines the exact size of the tumor. The proposal as advised by Andrew et al, has four segments of angiofibroma.…”