J Neurol Surg B Skull Base 2013; 74 - A163
DOI: 10.1055/s-0033-1336287

Endoscopic Graduated Multi-Angle Multi-Corridor Resection of Juvenile Nasopharyngeal Angiofibroma

James K. Liu 1(presenter), Qasim Husain 1, Saurin Sanghvi 1, Mohemmed N. Khan 1, Chirag R. Patel 1, Jean Anderson Eloy 1
  • 1Fair Lawn, NJ, USA

Introduction: Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNA with greater surgical freedom and decreased incidence of facial deformity and scarring.

Methods: We present four cases of JNA (each with a different surgical complexity) that were resected using a graduated multi-angle multi-corridor approach. Four different surgical corridors in varying combinations were used to resect JNAs based on tumor size and location, as illustrated through these four cases. These four corridors included: (1) an ipsilateral endonasal approach (uni-nostril), (2) a contralateral transseptal approach (bi-nostril), (3) a sublabial transmaxillary endoscopic-assisted Caldwell-Luc approach, and (4) an orbitozygomatic approach (transcranial).

Results: A graduated multi-angle multi-corridor approach was used in a stepwise fashion to allow maximal surgical exposure and maneuverability for resection of JNA. Gross-total resection was achieved in all four patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications.

Conclusions: A multi-angle multi-corridor approach allows for surgical customization of access for resection of JNAs, depending on the size and exact location of the tumor. This graduated stepwise method, utilizing the previously mentioned approaches, is a safe and effective technique that is tailored to the individual pathology. Combining the endoscopic endonasal approach with a transcranial approach may be considered in giant extensive JNAs that have intracranial involvement.