Surgical resection of type III juvenile angiofibroma without preoperative embolization

Summary Objectives/hypothesis To evaluate the outcome of surgical resection of type III juvenile angiofibroma without preoperative embolizationo in 20 young male patients. Patients and methods Twenty young male patients with type III JAF (based on Fisch classification by CT/MRI or both), were operated on by endoscopic-assisted midfacial degloving approach without preoperative embolization. The surgical technique is described in details. Results Apart from a case developed cerebrospinal fluid rhinorrhea (CSF) intraoperatively there were neither major operative nor postoperative complications. CSF leak was repaired through the same approach successfully in the same set. Eighteen patients had complete tumor clearance with no residual or recurrence during the follow up period which ranged from 6 months to 10 years. Recurrence was detected early by endoscopic examination in two cases (3 and 8 months postoperatively) and confirmed by CT and MRI. Endoscopic transnasal removal of the recurrent JAF was done successfully under local anesthesia in the first patient and under general anesthesia in the second with no recurrence during the follow up period. Conclusions Surgical resection of stage III JAF without embolization through endoscopic assisted midfacial degloving approach can be used as an adequate surgical technique with acceptable intraoperative blood loss and low rate of recurrence.