Juvenile nasopharyngeal angiofibroma: Evaluation and surgical management of advanced disease

Objective: Evaluate preoperative imaging in predicting operative stage. Describe the outcomes in surgically treated juvenile nasopharyngeal angiofibroma (JNA) with the influence of middle cranial fossa, carotid, or dural involvement on recurrence. Study Design: Retrospective cohort of surgically treated patients with JNA. Subjects and Methods: Eighty-five patients from a regional Italian referral center were assessed for recurrence, radiologic, and operative staging. High risk areas involved were recorded at surgery. Results: Recurrence for advanced disease (IIIb+) was 18.2% (6 of 33) and 15.3% (13 of 85) overall. Preoperative staging poorly correlated with operative stage (P = 0.15). No single high risk area was predictive for recurrence, but the absence of any risk factor was associated with a favorable outcome (P < 0.01). Conclusion: Dural involvement by tumor is rare and imaging may overstage disease. Anterior access, endoscopic or open, is sufficient to address intracranial involvement. When an open approach is used, a midface degloving technique affords excellent exposure even for advanced disease. Lateral approaches with their associated morbidity can be reserved for selected recurrent disease.