J Neurol Surg B 2017; 78(01): 063-067
DOI: 10.1055/s-0036-1584903
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Juvenile Nasal Angiofibromas: A Comparison of Modern Staging Systems in an Endoscopic Era

Nicholas R. Rowan1, Nathan T. Zwagerman2, Molly E. Heft-Neal3, Paul A. Gardner2, Carl H. Snyderman1, 2
  • 1Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • 2Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • 3University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
Further Information

Publication History

03 January 2016

27 May 2016

Publication Date:
06 July 2016 (eFirst)

Abstract

Objectives To compare the clinical utility of four juvenile nasal angiofibroma (JNA) staging systems in a large cohort of patients.

Design Retrospective case series.

Setting Tertiary referral academic center.

Participants Pediatric patients undergoing surgical resection of JNAs between January 2008 and June 2015.

Main Outcome Measures Intraoperative blood loss and transfusions, number of staged operations, postoperative residual disease, and recurrent disease.

Results In total, 34 patients were identified; all underwent preoperative embolization followed by surgery. Of the 34 patients, 33 (97%) underwent an exclusively endoscopic surgical approach, with 6 (18%) requiring planned staged operations. Ten (29%) patients had residual disease and three (9%) required further surgical resection. Using the area under the curve (AUC) of receiver operating characteristic curves, the University of Pittsburgh Medical Center (UPMC) staging system was most predictive of patients who required staged procedures, received intraoperative transfusions, and had residual postoperative disease (AUC: 0.89, 0.88, 0.86, respectively).

Conclusions The UPMC JNA staging system accounts for both route of skull base extension and tumor vascularity, which are two important tumor attributes in the age of preoperative embolization and endoscopic endonasal surgery. The UPMC staging system is a reliable modern staging system that closely reflects prognostic information and aids in surgical planning.