Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases.

OBJECTIVES/HYPOTHESIS This study is a review of the treatment outcomes of juvenile nasopharyngeal angiofibroma (JNA) specifically comparing endoscopic, endoscopic-assisted, and open surgical approaches. STUDY DESIGN Systematic review of studies using the MEDLINE database. METHODS A systematic review of studies on JNA from 1990 to 2012 was conducted. A search for articles related to JNA, along with bibliographies of those articles, was performed. Articles were examined for individual patient data (IPD) and aggregate patient data (APD). Demographics, presenting symptoms, surgical approach, follow-up, and outcome were analyzed. RESULTS Eighty-five articles were included, with IPD reported in 57 articles (345 cases) and APD in 28 articles (702 cases). For the IPD cohort, average follow-up was 33.4 months (range, 0.5-264 months). Average blood loss was 544.0 mL, 490.0 mL, and 1579.5 mL for endoscopic, endoscopic-assisted, and open surgical cases, respectively (P < .05). Recurrence rate following endoscopic surgery and open surgery were significantly less than endoscopic-assisted surgery (P < .05). In the APD cohort, the recurrence rate following endoscopic surgery was 4.7% compared to 20.6% in the endoscopic-assisted group and 22.6% in the open surgery group (P < .05). Among studies that reported Radkowski/Sessions grading, there was no significant difference in recurrence rates for both the IPD and APD cohorts across each stage between open and endoscopic surgery (P > .05). CONCLUSIONS In this study, endoscopic resection had a significantly lower intraoperative blood loss and lower recurrence rate when compared to open resection. However, there was no difference in recurrence rate when analyzing the IPD and controlling for Radkowski/Sessions grading. Therefore, further large-scale studies may be required to fully elucidate treatment options.