A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement.

OBJECTIVES/HYPOTHESIS: Although transnasal endoscopic resection has become an established treatment for most juvenile nasopharyngeal angiofibroma (JNA), surgical management of JNA with intracranial extension remains challenging. This study systematically reviews the JNA literature to determine surgical outcomes.

STUDY DESIGN

Systematic review.

METHODS

A systematic search of the PubMed was undertaken using a combination of MeSH terms: angiofibroma, nasopharynx. The search was limited to articles published in the English language between January 1990 and April 2012. Each article was reviewed to identify sufficient individual data on patients treated for JNA, defined as reporting on demographics, JNA stage, the specific surgical approach, complications, and length of follow-up for each patient.

RESULTS

A total of 72 patients from 15 studies were included in this review. The mean age was 15.7 years. The mean follow-up period was 47 months. Most patients had a craniofacial procedure. The overall mean estimated intraoperative blood loss was 1,709 mL. Preoperative embolization resulted in significantly less blood loss. The most common complications were sinonasal and neurological. Facial paresthesia was reported in 16%, followed by ophthalmoplegia (12%) and intranasal crusting (12%). Recurrence was reported in 13 patients (18%), which were detected between 7 and 26 months during the follow-up period. Overall, 86% of the cohort was free of disease.

CONCLUSIONS

Surgical management of JNA with intracranial extension is complex and requires an expert multidisciplinary team. Although craniofacial approaches appear to be the current standard of treatment, there is increased experienced-based evidence that endoscopic resection of large tumors or endoscopic-assisted resection is feasible in expert hands.

LEVEL OF EVIDENCE

3a.