Endoscopic Management of Juvenile Nasopharyngeal Angiofibroma without Routine Preoperative Embolization: A Simulated Single-Center Series of 153 Patients

Abstract

Objective: To evaluate a structured endoscopic strategy for juvenile nasopharyngeal angiofibroma (JNA) based on preoperative vascular mapping, early identification and control of feeding vessels, and stage-adapted tumor mobilization, without routine preoperative embolization.

Methods: This simulated retrospective cohort includes 153 adolescent and young adult male patients undergoing endoscopic resection of JNA at a high-volume rhinology and skull-base center. Preoperative contrast-enhanced CT and MRI were used to define tumor extension and probable vascular supply. Intraoperatively, the dominant feeding artery and its branches were identified before definitive tumor mobilization and controlled using a combination of bipolar coagulation, clipping, and selective vessel sealing. Estimated blood loss, transfusion requirement, operative time, residual disease, complications, and recurrence were analyzed according to tumor stage.

Results: The simulated cohort had a median age of 16 years (range, 10–27 years). Complete endoscopic resection was achieved in 147 patients (96.1%). Median estimated blood loss was 210 mL (IQR, 120–420 mL). Blood transfusion was required in 18 patients (11.8%), predominantly in advanced-stage disease. Major perioperative complications occurred in 5 patients (3.3%). During a simulated median follow-up of 30 months, radiologic or endoscopic recurrence was identified in 7 patients (4.6%). Blood loss increased progressively with tumor extension, particularly with infratemporal and intracranial involvement.

Conclusion: In this simulated series, a strategy combining detailed vascular imaging with early surgical control of feeding vessels was associated with high rates of complete endoscopic resection and acceptable blood loss without routine preoperative embolization. Prospective validation and comparison with embolization-based protocols are required.