Juvenile nasopharyngeal angiofibroma: vascular determinates for operative complications and tumor recurrence.
OBJECTIVE
Operative complications and tumor recurrence in juvenile nasopharyngeal angiofibroma (JNA) are measurable and meaningful outcomes. This study aimed to assess the association of these two outcomes to various clinical indices and in particular, vascular determinates.


METHODS
Retrospective cohort study.


METHODS
An 18-year retrospective chart review of an academic tertiary center was undertaken. Data from clinical notes, imaging studies, and arteriograms were analyzed.


RESULTS
Thirty-seven male (mean age, 14.4 years) patients were included in the study. Tumor stages included: IA (three), IB (three), IIA (14), IIB (three), IIC (five), IIIA (five), and IIIB (four). Four complications (cerebrospinal fluid leak, cerebral vascular accident, and two transient ocular defects) occurred. Eight recurrences occurred within 24 months following surgery. Complications were associated with estimated intraoperative blood loss (EBL) (P = .045). Tumor recurrence was associated with feeding vessels from the contralateral internal carotid artery (ICA) (P = .017). EBL was significantly associated with surgical technique used. EBL, tumor stage, and tumor vascular supply were significantly associated with each other.


CONCLUSIONS
Vascular factors were associated with JNA complication and tumor recurrence. EBL might affect complications, and contralateral ICA as a feeding vessel might affect recurrence. EBL was influenced by procedure choice and was interrelated to size and vascular supply of the tumor. This study bolsters the need to decrease intraoperative blood loss by preoperative embolization and use of endoscopic removal techniques. Furthermore, when branches of the ICA are found to be feeding vessels, greater surgical attention for a dry surgical field is encouraged.
Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A.
Kenny H
KH
Chan
Dexiang
D
Gao
Patrick G
PG
Fernandez
Todd T
TT
Kingdom
David A
DA
Kumpe
D000046:Academic Medical Centers; D000293:Adolescent; D018322:Angiofibroma / Q000098:blood supply* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000792:Angiography / Q000379:methods; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009389:Neovascularization, Pathologic / Q000401:mortality / Q000473:pathology*; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
Nasopharynx; head and neck (malignancy); nasopharyngeal angiofibroma