Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma (JNA) – Surgical Video

Case Summary

A 10-year-old patient with an advanced Juvenile Nasopharyngeal Angiofibroma involving the nasopharynx, infratemporal fossa, sphenoid sinus, and paracavernous region underwent complete endoscopic resection. This operative video demonstrates the surgical technique, vascular control, skull base reconstruction, and strategies used to minimise recurrence.

Watch the Surgical Video

Surgical Technique

This video demonstrates the endoscopic resection of a Juvenile Nasopharyngeal Angiofibroma (JNA) using a completely scarless endonasal approach.

The procedure begins with an endoscopic medial maxillectomy to expose the tumour within the infratemporal fossa. The internal maxillary artery is identified and controlled using bipolar cautery following pre-operative embolization, allowing safe devascularization before tumour removal.

A four-handed endoscopic technique is used throughout the procedure to achieve precise dissection while preserving surrounding vital structures.

Tumour Resection

The tumour is removed in a stepwise manner from the:

• Infratemporal fossa
• Nasopharynx
• Sphenoid sinus

Blunt dissection and an endoscopic shaver are used to progressively debulk the tumour while avoiding excessive traction near the skull base and internal carotid artery.

Throughout the operation, meticulous haemostasis is maintained to ensure excellent visualization.

Skull Base Reconstruction

Following complete tumour removal, the exposed skull base is reconstructed using autologous bone and fat grafts, supported with Surgicel and dural sealant.

The pterygoid plates are drilled to minimise the risk of tumour recurrence while preserving adjacent critical structures.

Operative Outcome

The tumour is successfully removed through a completely endoscopic approach without any external incision.

The procedure demonstrates the advantages of modern endoscopic skull base surgery, including excellent visualization, effective vascular control, minimal blood loss, and avoidance of facial scars.

This educational video allows students and patients to make informed decisions about their own and others’ health. Dr Akbar Abbas is a leading figure in ENT surgery within Pakistan, offering hope and expertise to countless patients facing similar challenges. He specializes in otolaryngology, cochlear implants, and ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan. Presently serving at Aga Khan University and Hospital.