Combined Approach for Excision of Advanced Angiofibroma: A Study of 12 Cases

Objective: To determine effectiveness of combined skull base approach for excision of advanced angiofibroma.

Patients and Methods: This study was conducted in the Department of Ear, Nose, Throat, Head and Neck surgery and Neurosurgery, Post Graduate Medical Institute Lady Reading Hospital Peshawar. This was retrospective observational study. The duration of the study was 5 years from Jan. 2008 to Dec. 2012.This study included 12 cases with advanced (stage IIIA and IVB) of nasopharyngeal angiofibroma. These cases were assessed in terms of detailed history, thorough examination and radiological investigations to stage according to the Fisch classification. The tumor was completely excised by combined approach of a team of Neurosurgeons and ENT surgeons. No recurrence found in 30 months post-op observation.

Results: This study included 12 cases .All were male .Age of the patients was in range of 14 to 19 years with mean of 16.5 years. They belonged to lower and middle class of society. They presented with history of unilateral nasal obstruction (100%) followed by recurrent epistaxis (80%).CT scans were performed in all cases (100%) while MRI where needed. The disease was involving nose, nasopharynx, sinuses and had Extracranial and intracranial extension. Nine cases (75%) were in stage IIIB and 3 cases (25%) in stage IVA according Fisch classification. The procedure time was average 7.5 hours and average 700 ml blood was transfused. Palatal fistula formed in one case (8.3%) and no recurrence found on 30 months follow up.

Conclusion: The cooperation of neurosurgeons and Otorhinolaryngological consultant provides a good way to minimize invasiveness in skull base surgery. Sufficient preoperative preparation, well-equipped theater and surgical expertise are necessary for complete resection of benign tumor like angiofibroma.

Keywords

angiofibroma - combined skull base approach - advanced angiofibroma