Endoscopic resection of juvenile angiofibromas--long term results.

OBJECTIVE To evaluate the long term outcome after endoscopic endonasal resection of juvenile nasopharyngeal angiofibromas (JNA). METHODS Retrospective study of a series of 21 consecutive patients undergoing endoscopic resection of JNA (type I - IIIa according to Fisch) at two Hospital Centers between 1993 and 2002. Mean follow-up was 51.7 months (range 5-120). Extension to the medial aspect of infratemporal fossa and retromaxillary space was no contraindication against an endonasal endoscopic approach. In three cases of type IIIa tumours a computer assisted intraoperative guiding system was applied (ENTrak, GE Medical, Lawrence, USA). RESULTS Fifteen patients (71.4%) were free of disease after one endoscopic resection. Three patients (14.3%) had an unmistakable recurrence with the need for further treatment at 6, 14, and 23 months, respectively. Two of the three recurrent tumours have been successfully resected endoscopically, one case was treated with gamma knife. In three patients (14.3%) postoperative MRI showed localized enhanced signal, presumably minimal persistent tumour tissue. Without further treatment all of these patients remained free of symptoms and MRI follow up showed no tumour growth over three, five and ten years, respectively. No postoperative long term sequela was observed. CONCLUSIONS Resection of nasopharyngeal angiofibromas type I-IIIa can be safely achieved endoscopically. The advantage of this minimally invasive technique is avoidance of external scars and low morbidity. The intraoperative computer assisted guiding system ENTrak was highly accurate and provided substantial help in selected cases.