Novel Surgical Strategy System for Juvenile Nasopharyngeal Angiofibroma: A Focus on Feeding Artery Management.

OBJECTIVES

For intraoperative bleeding control in patients with juvenile nasopharyngeal angiofibroma (JNA), we developed a novel surgical strategy system. This system is focused on feeding artery management, based on the spatial relationship between the tumor entity and feeding artery as determined by three-dimensional reconstruction.

METHODS

This historical controlled study was conducted at a tertiary medical institution from October 2013 to September 2022. The retrospective group comprised of previous JNA patients received traditional nasoendoscopic sursery. Three-dimensional CT reconstruction based on their preoperative contrast-enhanced CT and CTA was used for segmentation of spatial relationship between dominant feeding artery (DFA) and tumor entity. The prospective group comprised JNA patients undergoing endoscopic/endoscopic-assisted surgery reinforced DFA management by intraoperative ligation. Efficacy evaluation between two groups focused on intraoperative bleeding, complete resection rate and Postoperative hospitalized duration.

RESULTS

Twelve patients were included in the retrospective group. The three-dimensional reconstruction models were successfully performed, and the DFA was located in all patients. According to the segmentation of the DFA, we established a novel surgical strategy system focused on feeding artery management. All 11 patients in the prospective group underwent successful management of the DFA by intraoperative ligation with less intraoperative bleeding.

CONCLUSIONS

In this study, we introduced a novel surgical strategy system for JNA. The system focuses on feeding artery management, ensuring bleeding control based on the location of DFA on three-dimensional image reconstruction. As a result of clear and straightforward image classification, intraoperative bleeding was decreased. This system may become a meaningful reference for JNA preoperative planning.