title: Exclusively endoscopic removal of juvenile nasopharyngeal angiofibroma: trends and limits.
abstract: OBJECTIVE
  To determine the feasible conditions for exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma.
  
  
  METHODS
  Retrospective study of 20 patients, with a mean follow-up of 22 months.
  
  
  METHODS
  Six academic referral hospitals.
  
  
  METHODS
  All patients had a preoperative computed tomographic or magnetic resonance imaging scan and at least 1 follow-up computed tomographic and/or magnetic resonance imaging scan 6 or 12 months after surgery. Exclusive endoscopic removal was performed using conventional functional endoscopic sinus surgery instrumentation after preoperative embolization.
  
  
  RESULTS
  Using Radkowski staging, 4, 7, and 9 patients had stage I, II and IIIA tumors, respectively. Seven patients were operated on for a recurrence after open surgery. Extension toward the sphenoid sinus, pterygomaxillary fossa, or infratemporal fossa could be removed. There was no attempt at endoscopic removal of deep skull base or temporal fossa invasion. The mean surgery duration was 135 minutes; mean dimensions of the tumor were 4.5 x 4 x 3 cm; and mean blood loss was 350 mL (median, 300 mL). No recurrences occurred in this series; there were small asymptomatic remnants in 2 cases.
  
  
  CONCLUSIONS
  An exclusively endoscopic management of juvenile nasopharyngeal angiofibroma appears to be effective for small to medium tumors. It should be considered as a first-choice option for these cases (in view of the minimal bleeding, shorter duration, and efficacy).
authors.affiliation: Ear, Nose, and Throat Surgery, Armand-Trousseau Children's Hospital, Assistance Publique-Hopitaux de Paris, France. gilles.roger@trs.ap-hop-paris.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Roger
authors.forename: Patrice
authors.initials: P
authors.lastname: Tran Ba Huy
authors.forename: Patrick
authors.initials: P
authors.lastname: Froehlich
authors.forename: Thierry
authors.initials: T
authors.lastname: Van Den Abbeele
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Klossek
authors.forename: Elie
authors.initials: E
authors.lastname: Serrano
authors.forename: Erea-Noel
authors.initials: EN
authors.lastname: Garabedian
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.forename: Patrick
authors.initials: P
authors.lastname: Froelich
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018322:Angiofibroma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000639:trends*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome