Juvenile nasopharyngeal angiofibroma with intracranial extension – A review of 29 cases

Abstract

Background: Complete resection has been the preferred treatment for extracranial juvenile nasopharyngeal angiofibromas (JNA) but resection of JNA with intracranial extension (ICE) can be quite challenging because of the associated risk of extensive haemorrhage. The aim of this study was to assess the neurological outcome of patients undergoing surgery for removal of JNA with ICE and analyse various perioperative anaesthetic factors that could possibly affect the outcome. Materials and Methods: This retrospective study was conducted including patients with JNA with ICE requiring combined otolaryngological and neurosurgical approach for tumour removal at our centre from January 2001 to December 2010. Patient's medical and anaesthesia records were reviewed and data regarding patient demography, pre-operative investigations, anaesthetic management, post-operative investigations and complications, number of days of intensive care unit (ICU) and hospital stay and Glasgow Outcome Scale (GOS) at the time of discharge from hospital were collected and reviewed. Results: A total of 29 patients were operated. The median age of presentation was 15 years. Nineteen patients (65.5%) had a good GOS of 5 at discharge, 7 (24.1%) had moderate outcome with GOS of 4 and 3 patients (10.3%) had poor outcome with GOS of ≤3. There was one mortality in our study. Perioperative factors affecting the GOS at discharge were amount of intra-operative blood loss, intra-operative infusion of packed red blood cells (RBCs) and colloid and post-operative haemoglobin. Conclusion: The outcome of patients with JNA is affected by intra-operative blood loss and transfusion.

Multimodal blood loss prevention bundle for endoscopic resection of juvenile nasopharyngeal angiofibroma: A case series

“…The blood loss in our series was similar to that in previous reports. [ 6 8 ] The number of units of blood transfused in our series was lesser than that in other studies,[ 7 8 ] which reported a higher rate of haemorrhage and a lower rate of preoperative embolisation. Embolisation reduces bleeding to a large extent due to the increased vascularity of the tumour.…”

“…[ 3 ] Few studies have described the anaesthesia management of JNA. [ 4 5 6 7 8 ] However, a bundle approach has not been studied. This series describes the application of a multimodal blood loss prevention bundle (MBLPB) approach [ Table 1 ] and its effect on blood loss and transfusion requirements in patients undergoing endoscopic resection of JNA.…”