Comparative analysis of the results of surgery for juvenile nasopharyngeal angiofibroma with the use of 3D reconstructions of computed tomography angiography

Rationale: The relapse rates after surgery for juvenile nasopharyngeal and/or skull base angiofibroma is in the range of 23 to 27.5%, which is mostly related to diagnostic issues. Aim: To perform a comparative analysis of the results of surgical treatment for juvenile nasopharyngeal and skull base angiofibroma based on our technique of 3D reconstructions of computed tomography angiograms in patients with primary tumors and with relapses. Materials and methods: We analyzed retrospectively the data from 32 patients with juvenile nasopharyngeal and skull base angiofibroma who had been diagnosed and treated from 2013 to 2017 (42 surgeries). Multislice computed tomography (MSCT) angiography with 3D reconstruction was used for the planning of surgical approaches. At days 3 to 7 after the surgery, in 31 patients with stages II, IIIa and IIIb (according to U. Fisch classification modified by R. Andrews, 1989), we looked for residual tumor tissues by MSCT with standard analysis and with 3D MSCT angiography reconstructions, comparing them with their corresponding baseline images. The patients were divided into two groups: group 1, 17 patients with primary tumors (median age 13.5 years), group 2, 14 patients who had been previously operated (median age 14 years). Both groups were comparable in their clinical and demographic characteristics, as well as in the tumor staging (p > 0.05). Results: The relapse rates were 22.58% (7 / 31 patients), being 11.76% (2 / 17) in the group 1 and 35.71% (5 / 14) in the group 2 (p > 0.05). In each group, the maximal difference in the resected tumor volume was found in stage II patients, with more radical resection in the patients with primary tumors (p < 0.05). Contrast-enhanced MSCT showed residual tumor masses in 19 patients (8, with primary tumors and 11, with relapses). From those, 10 patients (3 with primary tumors and 7 who had underwent surgery earlier) required second surgeries (4 patients were curatively operated, and 2 patients relapsed within 1 year). All other patients continue their follow-up monitoring. By the time the paper was submitted, the duration of their follow up was from 3 months to 3 years; no relapses were identified. The data obtained by 3D reconstructions of MSCT angiography correlated with summary reports from the Department of Diagnostic Radiology in 100% of cases. During follow-up, we had few cases of diagnostic discrepancies between the assessment reports by territorial radiologists and the conclusions obtained by our method, although these discrepancies were not statistically significant. Conclusion: 3D images obtained after the reconstruction make it possible to evaluate the tumor spread in relation to anatomical structures (for primary tumors), as well as the results of surgical treatment. Curative potential of surgical treatment for juvenile nasopharyngeal and skull base angiofibroma is lower with higher tumor stages.