Juvenile nasopharyngeal angiofibroma: An update of therapeutic management

Background. Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx composed of fibrous connective tissue and an abundance of endothelium-lined vascular spaces. The name of the disease is derived from the fact that it occurs during adolescence, almost exclusively in boys. Methods. This study examines the natural characteristics of JNA, the imaging techniques used to diagnose and stage the neoplasm, and the treatment approaches used to manage the disease. Results. Forty-three cases of JNA diagnosed and treated at The University of Texas M. D. Anderson Cancer Center over a 38-year period were reviewed for the study. The cases were divided into two groups, those occurring between 1955 and 1974 and those occurring between 1975 and 1991, to accurately represent the developments in diagnostic and treatment methodology during those time periods. Conclusion. The results of our study show that: (1) the imaging techniques used after 1965 (angiography, computed tomography, and magnetic resonance imaging) greatly improve the staging of JNA; (2) morbidity, recurrence, and intraoperative complications decrease when preoperative embolization and skull-based surgical approaches are used; and (3) surgical resection is the most common primary treatment, with chemotherapy and radiotherapy recommended as possible other options.