title: Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study.
abstract: Endoscopic resection has become an established surgical option for most juvenile nasopharyngeal angiofibromas (JNA). However, surgical management of JNA with intracranial extension remains challenging. This retrospective multicenter study reviews a series of patients with advanced stage JNA treated via endonasal/endoscopic approach.
  
  
  
  The experience of five academic tertiary or quaternary care ORL-HNS Departments were included. Medical records of all patients operated for JNA staged as Radkowski stage IIIA or IIIB were reviewed. Main outcome measures included intraoperative blood loss, length of hospital stay, complication rate, and rate of persistence or recurrence.
  
  
  
  A total of 74 male patients with stages IIIA and IIIB were included. The mean age was 16.4 years and preoperative embolization was performed in 71 patients. The mean blood loss in 45 patients for whom the data was available was 1279.7 ml. The more anatomic subsites were involved, the higher the risk was of intraoperative bleeding. The mean follow-up for 54 out of 73 patients was 37.9 months. Patients with residual disease are significantly linked to involvement of combined (anterior-lateral and posterior) anatomic subsites and to a higher number of affected subsites. At last follow-up, all patients were asymptomatic and those with residual tissue displayed no imaging signs of growth.
  
  
  
  This retrospective multicenter study supports the notion that expanded endonasal endoscopic approaches for advance staged JNA are a feasible option associated with good long-term results.
authors.affiliation: Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Langdon
authors.affiliation: Hopital Lariboisiere, ENT Department, AP-HP, and EA 7334 REMES Paris 7, France.
authors.forename: P
authors.initials: P
authors.lastname: Herman
authors.affiliation: Hopital Lariboisiere, ENT Department, AP-HP, and EA 7334 REMES Paris 7, France.
authors.forename: B
authors.initials: B
authors.lastname: Verillaud
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Carrau
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: D
authors.initials: D
authors.lastname: Prevedello
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Nicolai
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Schreiber
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Padoan
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Castelnuovo
authors.affiliation: Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bernal-Sprekelsen
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D002648:Child; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult