Nasopharyngeal Angiofibroma - Staging and Selecting a Surgical Approach: Changing Trends

Abstract

ABSTRACT Objective The purpose of this study was to propose a new staging system which would allow for an accurate preoperative tumor assessment, appropriate surgical planning and to look for any changing trends in the surgical management of JNA. Study design and methods Retrospective chart review of 91 patients operated between Jan.1998 to Dec. 2007 at the Postgraduate Institute of Medical Education and Research, Chandigarh. The tumor location and extent was based on preoperative imaging reports and operative notes to review the staging system and surgical approaches. Results All patients were initially staged according to the modified sessions staging system. The revised staging system led to the reclassification of 36 (39.6%) in stage I A, I B and II A in the old staging system to stage I according to the new staging. Before 2003, none of the patients had undergone an endoscopic excision of the JNA, whereas 32 (35%) of patients underwent an endoscopic excision in group II (after 2002) with acceptable recurrence rates. Conclusions The choice of the surgical approach should be based on precise tumor location and in young patients the approach should be tailored to minimize potential for facial growth retardation. We recommend endoscopic resection for tumors confined to nasopharynx, nasal cavities, sinuses and minimal extension to PMF. Excision via lateral rhinotomy and its extensions and modifications is recommended for tumors having significant involvement of pterygomaxillary fossa, infratemporal fossa, cavernous sinus or minimal intracranial extension according to the surgeon's comfort and expertise.