Outcomes of Juvenile Nasopharyngeal Angiofibroma Resection at Mayo Clinic: A 15-Year Analysis

Objective: To characterize surgical outcomes of juvenile nasopharyngeal angiofibroma (JNA) resections performed at Mayo Clinic over a 15-year period, with particular focus on the relationship between tumor stage, surgical approach, and outcomes. Methods: Retrospective review of all patients with JNA who underwent resection at Mayo Clinic between January 2010 and January 2025. Demographics, presenting symptoms, University of Pittsburgh Medical Center (UPMC) stage, tumor volume, operative details, and outcomes were collected. Associations between tumor characteristics, surgical approach, and outcomes were analyzed. Results: Forty-four male patients (mean age, 18.0 ± 5.1 years) were included; 43 (97.7%) underwent preoperative embolization. Most (81.8%) had exclusively endoscopic resections, 13.6% combined endoscopic–open, and 4.5% open. Residual disease occurred in 6.8% and recurrence in 6.8% of patients during follow-up. Patients with advanced UPMC stage (IV–V) were significantly more likely to require open/combined approaches (41.2% vs 3.8%, p=0.004), had longer operative times (482.0 vs 317.6 minutes, p=0.001), and higher blood loss (365.0 vs 100.0 mL, p=0.006). In contrast, tumor volume was not significantly associated with surgical outcomes. Recurrence rates did not differ significantly by stage or by presentation with primary versus recurrent disease. Conclusion: In the modern era, most JNAs can be managed endoscopically with favorable outcomes. Advanced-stage tumors often necessitate combined or open approaches, with greater intraoperative morbidity but comparable outcomes. The UPMC staging system correlates more reliably with operative outcomes than tumor volume, underscoring its value for preoperative planning.