García-Fernández Alfredo, Fernández-Rueda María, García-González Esther, Mata-Castro Nieves
Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario 12 Octubre, Madrid, Spain.
Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario 12 Octubre, Madrid, Spain.
Auris Nasus Larynx. 2024 Dec;51(6):940-946. doi: 10.1016/j.anl.2024.09.004. Epub 2024 Sep 27.
Juvenile nasopharyngeal angiofibroma is an uncommon tumour primarily seen in young males. It is characterized by its vascular nature and aggressive growth pattern, presenting a significant surgical challenge. Endoscopic sinonasal surgery has become the treatment of choice, reducing both morbidity and blood loss, as well as recurrence rates. This study aims to present the clinical characteristics and surgical outcomes of patients with juvenile nasopharyngeal angiofibroma treated exclusively with endoscopic surgery at our centre.
A retrospective cohort study was conducted on cases of juvenile nasopharyngeal angiofibroma treated with endoscopic surgery at a single centre between 2013 and 2023.
A total of 21 patients were included in the study, with a mean age of 17.7 years. 57.14 % of the patients presented with an advanced stage (Stage ≥ IIc Radkowsky). The median volume was 79.2 cm. Pre-surgical embolization was performed in all cases. 7 patients (33.3 %) required blood transfusion. The need for blood transfusion was associated with greater tumour volume (p = 0.0028), intracranial extension (p = 0.025), extension to the infratemporal fossa (p = 0.024), and orbital extension (p = 0.026). There were 2 cases (9.5 %) of tumour recurrence/persistence, both classified as stage IIIb. Tumour persistence/recurrence was more common in patients with intracranial extension (p = 0.045).
Exclusive endoscopic resection of these tumours, regardless of volume and extension, does not increase the risk of blood loss or recurrence. Advanced-stage tumours, especially those with intracranial extension, present a higher risk of bleeding and tumour persistence. In these cases, the low morbidity of the endoscopic approach becomes more evident.
青少年鼻咽血管纤维瘤是一种罕见肿瘤，主要见于年轻男性。其特点是具有血管性质和侵袭性生长模式，给手术带来重大挑战。鼻内镜鼻窦手术已成为首选治疗方法，可降低发病率、减少失血及复发率。本研究旨在介绍在我们中心仅接受内镜手术治疗的青少年鼻咽血管纤维瘤患者的临床特征和手术结果。
对2013年至2023年在单一中心接受内镜手术治疗的青少年鼻咽血管纤维瘤病例进行回顾性队列研究。
本研究共纳入21例患者，平均年龄17.7岁。57.14%的患者为晚期（Radkowsky分期≥IIc期）。中位体积为79.2 cm³。所有病例均进行了术前栓塞。7例患者（33.3%）需要输血。输血需求与更大的肿瘤体积（p = 0.0028）、颅内扩展（p = 0.025）、颞下窝扩展（p = 0.024）和眼眶扩展（p = 0.026）相关。有2例（9.5%）肿瘤复发/残留，均分类为IIIb期。肿瘤残留/复发在有颅内扩展的患者中更常见（p = 0.045）。
无论肿瘤体积和扩展情况如何，单纯内镜切除这些肿瘤不会增加失血或复发风险。晚期肿瘤，尤其是有颅内扩展的肿瘤，出血和肿瘤残留风险更高。在这些情况下，内镜手术的低发病率更为明显。
