Endoscopic Treatment of Juvenile Angiofibromas: Experience of a Tertiary Center from 1993 to 2020

Objective: Juvenile angiofibromas are benign tumors that almost exclusively affect male adolescents. Over the last decades, there is an evolution from open surgery to less-invasive endoscopic techniques. Methods: The medical records of 39 consecutive patients who underwent endoscopic sinus surgery for a juvenile angiofibroma were retrospectively analyzed. Results: The distribution of the tumor stages according to the classification system of Radkowski was asfollows: 1 in stage IA, 5 in IB, 7 in IIA, 13 in IIB, 5 in IIC, 4 in IIIA, and 4 in IIIB. Preoperative angiography with embolization was performed in all but 1 patient. The mean postoperative follow-up time was 32 months. Five patients (12.8%) had a recurrence after a mean period of 9 months (range 3-24 months), of which 2 initially had incomplete macroscopic tumor removal due to intracranial extension. The mean operating time was 106 minutes (range 35-400 minutes). The mean duration of hospitalization was 4.3 days (range 1-9 days). Two patients (5.1%) had postoperative bleeding out of the internal maxillary artery for which a reintervention and blood transfusion was needed. Conclusions: Endoscopic surgery for juvenile angiofibromas is an effective and safe technique with good outcomes and low postoperative morbidity. This technique should be used as the first choice in the treatment of small to medium-sized tumors (I-IIB) and is a worthy alternative to open surgery for advanced tumor stages (IIC-IIIB) when performed by an experienced surgeon.