The Role of Tumor Extent and Post-Embolization Residual Vascularity in Endoscopic Endonasal Surgery for Juvenile Nasopharyngeal Angiofibroma.

BACKGROUND AND OBJECTIVES: This study investigates whether residual vascularity following preoperative embolization influences surgical outcomes in patients with juvenile nasopharyngeal angiofibroma (JNA) undergoing endoscopic endonasal surgery. METHODS: We retrospectively reviewed the medical records of 29 patients who underwent treatment at a tertiary referral hospital between January 2007 and December 2021. Patients were categorized according to the presence of residual vascularity after embolization and by tumor extent. Surgical outcomes were compared between groups, including estimated blood loss (EBL), transfusion requirements, total operation time, and the presence of residual tumor. RESULTS: Residual vascularity was observed in 19 patients (RV+) and was absent in 10 patients (RV-). Patients with extensive tumors exhibited a significant increase in EBL and transfusion requirements compared to those with limited tumors, regardless of residual vascularity status. While residual vascularity was associated with increased operation time, greater EBL, and a higher likelihood of transfusion, these differences were not statistically significant. CONCLUSION: Residual vascularity appears to have a less pronounced influence on surgical outcomes than tumor extent. However, patients with extensive tumors and residual vascularity tended to experience higher blood loss and transfusion rates. Tumor extent may therefore represent a more critical prognostic factor than residual vascularity in JNA surgery.