A new endoscopic staging system for angiofibromas.

OBJECTIVE To develop a new staging system for juvenile nasopharyngeal angiofibroma that reflects changes in surgical approaches (endonasal), route of intracranial extension, and the extent of vascular supply from the internal carotid artery. DESIGN Retrospective review of case series. SETTING Academic medical center. PATIENTS Patients undergoing endoscopic endonasal surgery for juvenile nasopharyngeal angiofibroma at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, from 1998 through 2008. INTERVENTION Patients were staged according to current systems and compared with a new staging system that also incorporated the route of skull base extension and tumor vascularity. MAIN OUTCOME MEASURES Estimated blood loss, number of operations, and tumor recurrence. RESULTS Skull base erosion was observed in 74% of cases. Following embolization of external carotid artery tributaries, residual vascularity from the internal carotid artery was seen in 51% of patients. Residual vascularity, classified as UPMC stage IV and V, strongly correlated with blood loss, requirement for multiple procedures, and residual or recurrent tumor. CONCLUSIONS Tumor size and extent of sinus disease are less important in predicting complete tumor removal with endonasal surgical techniques. The UPMC staging system for juvenile nasopharyngeal angiofibroma accounts for 2 important prognostic factors, route of cranial base extension, and vascularity and is applicable to endoscopic or open approaches. Compared with other staging systems, the UPMC staging system provides a better prediction of immediate morbidity (including blood loss and need for multiple operations) and tumor recurrence.