title: Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: a systematic review of the literature.
abstract: OBJECTIVE
  To systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications.
  
  
  METHODS
  Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles.
  
  
  METHODS
  The literature was searched by 2 reviewers with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models.
  
  
  RESULTS
  Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (minimum, 20 mL; maximum, 1482 mL). It was 414.6 mL (minimum, 20 mL; maximum, 1000 mL) and 774.2 mL (minimum, 228 mL; maximum, 1482 mL), respectively, in the group with and without embolization. No conclusion could be made because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval [CI], 8.3-11.7). It was 9.3% (95% CI, 7.2-11.5) for complications and 7.7% (95% CI, 5.4-10.1) for residual tumor.
  
  
  CONCLUSIONS
  The endoscopic treatment is an evolving modality. It is considered today the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.
authors.affiliation: Otolaryngology-Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon.
authors.forename: Nadim
authors.initials: N
authors.lastname: Khoueir
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nicolas
authors.forename: Ziad
authors.initials: Z
authors.lastname: Rohayem
authors.forename: Amine
authors.initials: A
authors.lastname: Haddad
authors.forename: Walid
authors.initials: W
authors.lastname: Abou Hamad
mesh_terms: D018322:Angiofibroma / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*
keywords: bleeding; complications; endoscopy; juvenile nasopharyngeal angiofibroma; recurrence