International Journal of Pediatric Otorhinolaryngology (2003) 67, 1219—1225 Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma T. Metin Önerci* , Ö. Ta¸ skın Yücel* , O˘ guz Ö˘ gretmeno˘ glu* Hacettepe University Medical Faculty, ENT Department, Ankara, Turkey Received 16 May 2002; received in revised form 26 July 2003; accepted 27 July 2003 KEYWORDS Endoscopy; Nasopharyngeal neoplasms Summary Objectives: Juvenile nasopharyngeal angiofibroma (JNA) is a highly vas- cular and locally invasive tumor with a high incidence of persistence and recurrence. The classical treatment of this tumor is surgery and/or radiotherapy. Use of endo- scopic techniques seems to be on the rise in treatment of these lesions. We tried to explore the roles and limits of endoscopic surgery alone or with classical surgical techniques in treatment of these tumors. Methods: Retrospective case review was conducted at a tertiary referral center. Twelve patients were treated for nasopha- ryngeal angiofibroma using endoscopic approach between 1998—2002. The staging, average blood loss during surgery, residual, and/or recurrent tumor were evaluated. Results: Eight of these patients (8/12) were up to stage IIC according to Radkowski staging. This group of patients has an average blood loss of 1000 ml and were followed for at least 6 months. We did not encounter any residual or recurrent tumor in this group. Four patients (4/12) had minimal intracranial extension, were staged IIIA, and had an average blood loss of 1500ml during surgery. Two of these patients had mini- mal residual tumor around the cavernous sinus, but showed no progression of disease over a follow-up of 2 years with MRI. Two patients had no residual or recurrent tumor over a follow-up of 6 months. Conclusion: This data suggests that endoscopic surgery can be used in the treatment of JNA even with minimal intracranial extension with minimal morbidity and low recurrence rate. © 2003 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Juvenile nasopharyngeal angifibroma (JNA) is a highly vascular and locally invasive tumor with a high incidence of persistence and recurrence [1]. The specific point of origin of the angiofibroma is on the posterolateral wall of the nose, where the sphenoid process of the palatine bone meets the horizontal ala of the vomer and the root of *Corresponding author. Present address: Ho¸ sdere Cad No. 49/13 06540, Y. Ayrancı/Ankara, Turkey. Tel.: +90—312-4665234; fax: +90-312-4665258. E-mail address: tyucel@tr.net (T.M. Önerci). the pterygoid proces of the sphenoid. This junc- tion forms the superior margin of the sphenopala- tine foramen [2]. There are also rare cases that were reported at extranasopharyngeal sites [3]. Although this tumor is histopathologically benign, recurrences can be seen. JNA grows by expansion initially to nasal cavity anteriorly. These extensions are not invasive in manner, but show fingerlike expansions. Superiorly, it grows into the sphenoid sinus and laterally through the sphenopalatine fora- men into the pterygomaxillary fissure. The tumor can show extension into the pterygopalatine fossa and then into the infratemporal fossa. Intracranial extension to middle cranial fossa is either through 0165-5876/$ — see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2003.07.013