Abstract
Objective We compare the open and transnasal approaches for the excision of juvenile nasopharyngeal
angiofibromas regarding the rate of morbidity, and residual tumor and its symptomatic
recurrence over time. In addition, we present volumetric measurements of juvenile
nasopharyngeal angiofibromas over time.
Methods All surgically treated patients of our institution were reviewed back to 1969 for
type of surgery, residual tumor by magnetic resonance imaging (MRI)-based volumetry,
recurrence, and morbidity. We performed a prospective clinical and radiological follow-up
on reachable patients.
Results In total, 40 patients were retrievable from our records. We were able to follow up
on 13 patients after a mean of 15.7 years since surgery (range: 1–47 years). Patients
operated by the open approach had a higher rate of postoperative complications and
thus a higher morbidity than endoscopic patients (4/4 vs 3/9; p = 0.007), although tumor sizes were equal among groups (p = 0.12). Persisting tumor was noted in 3/4 and 4/9 (p = 0.56) patients, respectively. The corresponding mean volumes of residual tumors
were 16.2 ± 14.4 cm3 and 10.8 ± 6.6 cm3 (p = 0.27). No progression could be noted in endoscopically treated patients (p = 0.24, mean time between scans 2 years).
Conclusions Our analysis shows that the endoscopic approach results in less morbidity. The open
approach does not guarantee freedom from persisting tumor tissue. Age seems to be
a most important risk factor for the conversion of an asymptomatic persistence into
a symptomatic recurrence.
Keywords
angiofibroma - follow-up - morbidity - endoscopic surgery - infratemporal approach
