Long-term follow-up of juvenile nasopharyngeal angiofibromas: Analysis of recurrences

Objectives: Juvenile nasopharyngeal angiofibroma often recurs if the tumor is large. This report is a long-term follow-up of these cases. It establish es the prognostic values of tumor extensions, analyzes the anatomic factors involved in recurrences, describes the spontaneous evolution of remnants b ased on a radiographic follow-up, and evaluates the pertinence of complex c ombined surgical approaches for invasive tumors and the value of complement ary endoscopy. Study Design: Retrospective review of 44 cases treated betwe en 1985 and 1996. Methods: Statistical analysis of the correlation between recurrence and tumor extension as evaluated by systematic analysis of 18 pu tative tumor extensions on preoperative computed tomography scans. Results: Invasion of the skull base affected two-thirds of the patients, and the ra te of recurrence was 27.5%, Extensions to the infratemporal fossa, sphenoid sinus, base of pterygoids and clivus, the cavernous sinus (medial), foreme n lacerum, and anterior fossa were correlated with more frequent recurrence . Long-term radiographic follow-up revealed putative residual disease in ni ne asymptomatic patients: these remnants gradually involuted. Conclusions: The data in the current study emphasize the prognostic value of skull base invasion and the difficulty of complete resection of extended lesions. Tumo r remnants detected in symptom-free patients should be kept under surveilla nce by repeated computed tomography scan, since involution may occur. Recur rent symptoms may be treated by radiotherapy (30 Gy) rather than by extende d combined procedures. Endoscopic surgery should be combined with surgery f or better control of skull base extensions.