# Total Endoscopic or Endoscope-Assisted Excision of Non-embolized Advanced Juvenile Nasopharyngeal Angiofibroma: A Clinical Case Series

## TL;DR

This study shows that endoscopic or endoscope-assisted surgery can safely and effectively remove advanced juvenile nasopharyngeal angiofibromas without preoperative embolization.

## Contribution

The study demonstrates the feasibility of endoscopic approaches for non-embolized advanced JNA, challenging the need for preoperative embolization.

## Key findings

- Six patients with advanced JNA had complete tumor removal using endoscopic or endoscope-assisted techniques.
- No residual disease was observed on postoperative CT scans at six months.
- The procedures were associated with minimal complications and low blood transfusion requirements.

## Abstract

Background

Surgical excision is the primary treatment for juvenile nasopharyngeal angiofibroma (JNA), but this procedure is challenging due to its high vascularity and local aggressiveness. Moreover, preoperative embolization is a subject of debate.

Objective

The objective of this study is to assess the efficacy, safety, and feasibility of endoscope-assisted excision as a surgical intervention for non-embolized advanced JNA.

Materials and methods

This case series involved six male patients (mean age: 16 years) with JNA, classified as stages Ⅱc to Ⅲb according to the Radkowski classification. None underwent preoperative embolization.

Results

Two stage Ⅱc cases underwent total endoscopic endonasal excision. One patient with stage Ⅲa and another with stage Ⅲb underwent surgery via an endoscope-assisted sublabial approach. Two patients, one with stage Ⅱc JNA and another with Ⅲb, underwent a two-stage procedure. Postoperative CT scans showed no residual disease at the six-month mark. On average, each procedure required 1.5 units of blood transfusion. One patient experienced intraoperative bleeding, whereas the remaining patients were free of any major complications. The mean operation duration was 175 minutes per procedure. The mean length of stay at the hospital was 3.75 days per procedure.

Conclusion

Endoscope-assisted or purely endoscopic approaches can be safely and effectively employed for the complete excision of non-embolized advanced JNAs.