Endoscopic surgery for juvenile angiofibroma: when and how.
OBJECTIVE
In recent years, the indications for endoscopic surgery of the sinonasal tract, originally introduced for the treatment of inflammatory diseases, have been expanded to include selected cases of benign and malignant neoplastic lesions. The aim of the present study was to establish the efficacy of endoscopic surgery in the management of small and intermediate-sized juvenile angiofibromas.


METHODS
Retrospective study.


METHODS
We reviewed the clinical records and the preoperative and postoperative imaging studies of 15 patients with juvenile angiofibroma who were treated with an endoscopic approach after embolization in the period from January 1994 to April 2000. All patients were prospectively followed by endoscopic and magnetic resonance imaging evaluations performed at regular intervals (every 4 months during the first year and, subsequently, every 6 months).


RESULTS
According to a staging system reported in 1989, there were two patients with a type I, nine with a type II, three with a type IIIA, and one with a type IIIB juvenile angiofibroma. Angiography demonstrated that the vascular supply was strictly unilateral in 11 patients and bilateral in 4. Intraoperative blood loss ranged from 80 to 600 mL (mean blood loss, 372 mL). During follow-up (range, 24-93 mo; mean follow-up, 50 mo [SD +/- 19.9 mo]), only one patient presented a residual lesion on magnetic resonance imaging, which was 16 mm in diameter and was detected 24 months after surgery.


CONCLUSIONS
The endoscopic approach is a safe and effective technique that allows removal of small and intermediate-sized juvenile angiofibromas (without extensive involvement of the infratemporal fossa and cavernous sinus) with a low morbidity. Advanced lesions are more appropriately treated by external approaches.
Nicolai
Piero
P
Department of Otorhinolaryngology, University of Brescia, Italy.
Berlucchi
Marco
M
Tomenzoli
Davide
D
Cappiello
Johnny
J
Trimarchi
Matteo
M
Maroldi
Roberto
R
Battaglia
Giuseppe
G
Antonelli
Antonino R
AR
D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic; D004724:Endoscopy / Q000379:methods*; D004844:Epistaxis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015508:Nasal Obstruction / Q000209:etiology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010255:Paranasal Sinus Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors