Juvenile nasopharyngeal angiofibroma

Vascular determinates for operative complications and tumor recurrence

Authors

  • Kenny H. Chan MD,

    Corresponding author
    1. Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
    • Send correspondence to Kenny H. Chan, MD, Department of Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, B-455, Aurora, CO 80045. E-mail: kenny.chan@childrenscolorado.org

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  • Dexiang Gao PhD,

    1. Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, U.S.A
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  • Patrick G. Fernandez MD,

    1. Department of Anesthesiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
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  • Todd T. Kingdom MD,

    1. Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
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  • David A. Kumpe MD

    1. Department of Radiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Operative complications and tumor recurrence in juvenile nasopharyngeal angiofibroma (JNA) are measurable and meaningful outcomes. This study aimed to assess the association of these two outcomes to various clinical indices and in particular, vascular determinates.

Study Design

Retrospective cohort study.

Methods

An 18-year retrospective chart review of an academic tertiary center was undertaken. Data from clinical notes, imaging studies, and arteriograms were analyzed.

Results

Thirty-seven male (mean age, 14.4 years) patients were included in the study. Tumor stages included: IA (three), IB (three), IIA (14), IIB (three), IIC (five), IIIA (five), and IIIB (four). Four complications (cerebrospinal fluid leak, cerebral vascular accident, and two transient ocular defects) occurred. Eight recurrences occurred within 24 months following surgery. Complications were associated with estimated intraoperative blood loss (EBL) (P = .045). Tumor recurrence was associated with feeding vessels from the contralateral internal carotid artery (ICA) (P = .017). EBL was significantly associated with surgical technique used. EBL, tumor stage, and tumor vascular supply were significantly associated with each other.

Conclusions

Vascular factors were associated with JNA complication and tumor recurrence. EBL might affect complications, and contralateral ICA as a feeding vessel might affect recurrence. EBL was influenced by procedure choice and was interrelated to size and vascular supply of the tumor. This study bolsters the need to decrease intraoperative blood loss by preoperative embolization and use of endoscopic removal techniques. Furthermore, when branches of the ICA are found to be feeding vessels, greater surgical attention for a dry surgical field is encouraged.

Level of Evidence

4 Laryngoscope, 124:672–677, 2014

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