Endoscopic Surgery for Juvenile Nasopharyngeal Angiofibroma: Tips for Success

PROGRAM DESCRIPTION: Juvenile nasopharyngeal angiofibromas are challenging tumors to resect secondary to their vascularity and patterns of spread. The majority of tumors can be successfully removed using endoscopic techniques. This course will address: (1) pre-operative assessment and selection of patients for endoscopic surgery; (2) embolization techniques; (3) staging based on tumor vascularity; (4) endonasal and transmaxillary endoscopic approaches; (5) surgical strategy; (6) intraoperative hemostasis and surgical techniques; (7) instrumentation; (8) problem areas and surgical tips; (9) postoperative surveillance; and (10) management of residual/recurrent tumor. Techniques will be highlighted with case-based discussion augmented by extensive surgical videos. Specifically, the importance of removal of the pterygoid base to prevent recurrence, removal of tumor extending into the parapharyngeal space, managing intracranial spread to the middle cranial fossa and dissection of vascular contributions from the internal carotid artery will be demonstrated. This course will improve your ability to completely resect JNAs using endoscopic techniques.

OUTCOME OBJECTIVE 1: Properly stage angiofibromas based on tumor extent and vascularity.

OUTCOME OBJECTIVE 2: Develop a surgical strategy for the management of all stages of angiofibroma including giant tumors with intracranial extension.

OUTCOME OBJECTIVE 3: Utilize hemostatic surgical techniques to minimize intraoperative blood loss and remove tumors from difficult locations.

BACKGROUND STATEMENT: Endoscopic resection of juvenile nasopharyngeal angiofibroma can be challenging secondary to patterns of local spread and the vascular nature of the tumors. Strategies to manage blood loss and achieve complete tumor removal are critical.