Evaluating the Impact of Intraoperative Magnetic Resonance Imaging on the Resection of Juvenile Nasopharyngeal AngiofibromaEvaluating the impact of intraoperative MRI on the resection of juvenile nasopharyngeal angiofibroma.

Abstract

Background: Complete resection is essential in the management of juvenile nasopharyngeal angiofibroma (JNA), yet residual disease remains a major cause of recurrence, particularly in advanced cases. Intraoperative MRI (IO-MRI) may support intraoperative decision-making, but its clinical utility in JNA surgery remains unclear.

Aims/objectives: To evaluate the selective role of intraoperative MRI (IO-MRI) in intraoperative decision-making during endoscopic resection of JNA.

Material and methods: Nine patients who underwent endoscopic endonasal resection of JNA with IO-MRI assistance were retrospectively reviewed. IO-MRI findings, intraoperative management changes, and follow-up outcomes were evaluated.

Results: IO-MRI detected no residual tumor in seven patients (77.7%). In one case, residual disease identified on IO-MRI prompted additional resection during the same operation. In another case, a residual tumor involving critical neurovascular structures was detected, and further resection was avoided. No recurrence was observed in eight patients during follow-up, and no IO-MRI-related morbidity occurred.

Conclusions: IO-MRI may serve as a valuable adjunct in JNA surgery by supporting intraoperative decisions to either continue or safely limit resection. Its use appears most beneficial in anatomically complex or advanced-stage tumors.