ANGIOFIBROMA - CHANGES IN STAGING AND TREATMENT

Objective: To identify specific preoperative tumor characteristics and potential surgical decisions that ultimately place a patient at a gre ater risk for tumor recurrence. Design: The clinical presentation, man agement, and prognosis of 23 consecutive cases of juvenile nasopharyng eal angiofibroma were reviewed retrospectively from January 1, 1977, t o June 30, 1993. A minimum follow-up of 12 months was necessary for st udy inclusion. Setting: A single, tertiary care pediatric facility. In terventions: All available preoperative imaging studies were reevaluat ed to ensure consistency in reporting. Preoperative computed tomograph y was performed in 21 patients, but only 18 scans were available for r eview. Preoperative angiography with embolization was performed in 21 of 23 patients. Surgical excision was the primary mode of treatment in 22 of 23 patients, and complete surgical excision was possible in 21 of 23 patients. Main Outcome Measures: The rate of recurrence was exam ined with respect to time of presentations, initial tumor stage, intra operative blood loss, and surgical approach. Results: When compared wi th patients without a recurrent tumor, there was no difference in age at presentation, primary symptom, or duration of symptoms before diagn osis. Preoperative tumor stage was found to be the primary factor affe cting tumor recurrence. A recurrence rate of 21.7% (five of 23 patient s) was identified after an average 6-year follow-up. A trend toward us e of the midfacial degloving approach for surgical exposure was identi fied and was not associated with an increased risk of recurrence. All patients were ultimately cured of their tumor without the need for ope n craniotomy despite a 32% incidence of stage IIIA and IIIB tumors. No deaths were reported during the study. Conclusions: Juvenile nasophar yngeal angiofibromas are benign tumors occurring almost exclusively in adolescent males. Recent advances in radiographic imaging techniques allow for more accurate preoperative staging, especially in regard to skull base involvement. Recognition of the extent of the tumor before surgical extirpation reduces the risk of recurrence.