A Case of Juvenile Angiofibroma Removed by Segmental Resection with Vascular Embolization

Abstract

Juvenile angiofibroma is a benign tumor that predominantly affects adolescent males and invasively destroys the nasal sinuses and pterygopalatine fossa. The treatment of first choice is surgery, but there is a risk of recurrence due to intraoperative hemorrhage and difficulty in securing an adequate field of vision because of the location of the tumor in the posterior nasal cavity. In this study, we report a case in which a Radkowski stage IA tumor was removed endoscopically by segmental resection. The patient was a 21-year-old male with a hemorrhagic tumor in the left posterior nasal cavity. Computed tomography and magnetic resonance imaging showed a markedly enhancing tumor measuring approximately 35 mm in diameter that obstructed the left posterior nasal cavity and nasopharynx. Preoperative embolization was performed the day before the surgery to reduce the tumor vascularity. Intraoperatively, the tumor was segmentally resected using a LigaSure^TM Maryland to improve visualization for surgical removal. The segmental resection allowed clear visualization of the base and complete removal of the tumor. Intraoperative bleeding was minimal and there was no postoperative recurrence. We believe that segmental resection is effective for patients in which it is difficult to secure an adequate visual field, even if the tumor is localized in the nasal cavity.