Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2014; 01(01): 040-045
DOI: 10.4103/2348-0548.124846
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Juvenile nasopharyngeal angiofibroma with intracranial extension – A review of 29 cases

Varun Jain
Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi
,
Surya Kumar Dube
Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi
,
Charu Mahajan
1   Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
,
Hemanshu Prabhakar
Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi
› Author Affiliations
Further Information

Publication History

Publication Date:
27 April 2018 (online)

   Permissions and Reprints

Abstract

Background: Complete resection has been the preferred treatment for extracranial juvenile nasopharyngeal angiofibromas (JNA) but resection of JNA with intracranial extension (ICE) can be quite challenging because of the associated risk of extensive haemorrhage. The aim of this study was to assess the neurological outcome of patients undergoing surgery for removal of JNA with ICE and analyse various perioperative anaesthetic factors that could possibly affect the outcome. Materials and Methods: This retrospective study was conducted including patients with JNA with ICE requiring combined otolaryngological and neurosurgical approach for tumour removal at our centre from January 2001 to December 2010. Patient's medical and anaesthesia records were reviewed and data regarding patient demography, pre-operative investigations, anaesthetic management, post-operative investigations and complications, number of days of intensive care unit (ICU) and hospital stay and Glasgow Outcome Scale (GOS) at the time of discharge from hospital were collected and reviewed. Results: A total of 29 patients were operated. The median age of presentation was 15 years. Nineteen patients (65.5%) had a good GOS of 5 at discharge, 7 (24.1%) had moderate outcome with GOS of 4 and 3 patients (10.3%) had poor outcome with GOS of ≤3. There was one mortality in our study. Perioperative factors affecting the GOS at discharge were amount of intra-operative blood loss, intra-operative infusion of packed red blood cells (RBCs) and colloid and post-operative haemoglobin. Conclusion: The outcome of patients with JNA is affected by intra-operative blood loss and transfusion.

Keywords

Anaesthesia - blood loss - juvenile nasopharyngeal angiofibroma - outcome
 

  • REFERENCES

  • 1 Martin H, Ehrlich HE, Abels JC. Juvenile nasopharyngeal angiofibroma. Ann Surg 1948; 127: 513-36
    CrossrefPubMedGoogle Scholar
  • 2 Herman P, Lot G, Chapot R, Salvan D, Huy PT. Long term follow-up of juvenile nasopharyngeal angiofibromas: Analysis of recurrences. Laryngoscope 1999; 109: 140-7
    CrossrefPubMedGoogle Scholar
  • 3 Bales C, Kotapka M, Loevner LA, Al-Rawi M, Weinstein G, Hurst R. et al. Craniofacial resection of advanced juvenile nasopharyngeal angiofibroma. Arch Otolaryngol Head Neck Surg 2002; 128: 1071-8
    CrossrefPubMedGoogle Scholar
  • 4 Bremer JW, Neel 3rd HB, DeSanto LW, Jones GC. Angiofibroma: Treatment trends in 150 patients during 40 years. Laryngoscope 1986; 96: 1321-9
    PubMedGoogle Scholar
  • 5 Tewfik TL, Tan AK, al Noury K, Chowdhury K, Tampieri D, Raymond J. et al. Juvenile nasopharyngeal angiofibroma. J Otolaryngol 1999; 28: 145-51
    PubMedGoogle Scholar
  • 6 Mann WJ, Jecker P, Amedee RG. Juvenile angiofibromas: Changing surgical concept over the last 20 years. Laryngoscope 2004; 114: 291-3
    CrossrefPubMedGoogle Scholar
  • 7 Gupta AC, Murthy DP. Intracranial juvenile nasopharyngeal angiofibroma. Aust N Z J Surg 1997; 67: 477-82
    CrossrefPubMedGoogle Scholar
  • 8 Tang IP, Shashinder S, Gopala Krishnan G, Narayanan P. Juvenile nasopharyngeal angiofibroma in a tertiary centre: Ten-year experience. Singapore Med J 2009; 50: 261-4
    PubMedGoogle Scholar
  • 9 Elsharkawy AA, Kamal EM, Tawfik A, Zaher A, Kasem M. Juvenile nasopharyngeal angiofibroma with intracranial extension: Analysis of 23 Egyptian patients. Int J Pediatr Otorhinolaryngol 2010; 74: 755-9
    CrossrefPubMedGoogle Scholar
  • 10 Donald PJ, Enepikedes D, Boggan J. Giant juvenile nasopharyngeal angiobroma: Management by skull-base surgery. Arch Otolaryngol Head Neck Surg 2004; 130: 882-6
    CrossrefPubMedGoogle Scholar
  • 11 Deschler DG, Kaplan MJ, Boles R. Treatment of large juvenile nasopharyngeal angiobroma. Otolaryngol Head Neck Surg 1992; 106: 278-84
    CrossrefPubMedGoogle Scholar
  • 12 Moulin G, Chagnaud C, Gras R, Gueguen E, Dessi P, Gaubert JY. et al. Juvenile nasopharyngeal angiofibroma: Comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovasc Intervent Radiol 1995; 18: 158-61
    CrossrefPubMedGoogle Scholar
  • 13 Ezri T, Roth Y, Geva D, Konichezky S, Marshak G, Halperin D. anesthetic management of juvenile nasopharyngeal angiobroma resection. J Cardiothorac Vasc Anesth 2003; 17: 622-4
    CrossrefPubMedGoogle Scholar
  • 14 Nicolai P, Berlucchi M, Tomenzoli D, Cappiello J, Trimarchi M, Maroldi R. et al. Endoscopic surgery for juvenile angiofibroma: When and how. Laryngoscope 2003; 113: 775-82
    CrossrefPubMedGoogle Scholar
  • 15 Thakar A, Gupta G, Bhalla AS, Jain V, Sharma SC, Sharma R. et al. Adjuvant therapy with flutamide for presurgical volume reduction in juvenile nasopharyngeal angiofibroma. Head Neck 2011; 33: 1747-53
    CrossrefPubMedGoogle Scholar
  • 16 Labra A, Chavolla-Magaña R, Lopez-Ugalde A, Alanis-Calderon J, Huerta-Delgado A. Flutamide as a preoperative treatment in juvenile angiofibroma (JA) with intracranial invasion: Report of 7 cases. Otolaryngol Head Neck Surg 2004; 130: 466-9
    CrossrefPubMedGoogle Scholar
  • 17 Gates GA, Rice DH, Koopmann Jr CF, Schuller DE. Flutamide induced regression of angiofibroma. Laryngoscope 1992; 102: 641-4
    CrossrefPubMedGoogle Scholar