Complications in the endoscopic and endoscopic-assisted treatment of juvenile nasopharyngeal angiofibroma with intracranial extension.
BACKGROUND
Although it is a rare neoplasm, juvenile nasopharyngeal angiofibroma (JNA) is associated with high rates of morbidity and mortality, with the potential for intracranial extension. Surgical excision is the main treatment. The external approach has largely been replaced by the endoscopic approach in small lesions, and it can be used as a complement in more advanced cases. However, there is no consensus in the literature regarding the complications of surgical treatment of JNAs with intracranial extension.


OBJECTIVE
To assess the prevalence of complications in endoscopic or endoscopic-assisted surgical treatment of JNA with minimal intracranial invasion.


METHODS
This was a retrospective cohort study of all patients with JNA with intracranial extension (Radkowski grade IIIa) treated with endoscopic, endoscopic-assisted, and external surgery from January of 1996 to May of 2010.


RESULTS
Thirteen patients underwent surgery. Endoscopic surgery was performed in three patients, without postoperative complications; endoscopic-assisted surgery in three others, with two instances of complications, and external surgery in seven.


CONCLUSIONS
Operative treatment of nasopharyngeal angiofibroma with intracranial extension is one of the major challenges of ENT and neurosurgical practice. The success rates and low intra- and postoperative complication rates of endoscopic surgery suggest that this route has been gaining ground in the management of Radkowski grade IIIa JNAs.
Universidade de São Paulo, São Paulo, SP, Brasil.
Maria Dantas Costa Lima
MD
Godoy
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Thiago Freire Pinto
TF
Bezerra
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Fabio de Rezende
Fde R
Pinna
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Richard Louis
RL
Voegels
D000293:Adolescent; D018322:Angiofibroma / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects; D006801:Humans; D008279:Magnetic Resonance Imaging; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult