The Management of Giant Juvenile Nasopharygeal Angiofibromas with Skull Base Invasion

Juvenile nasopharyngeal angiofibromas (JNA) are an uncommon benign tumor of uncertain etiology that begin in the sphenoid bone just at the origin of the pterygoid plates, usually found in pubertal males. Most of these tumors extend extracranially to the paranasal sinuses, infratemporal fossa, and occasionally to the orbit. Rarely do they extend to the intracranial space, mostly to the middle cranial fossa. They may invade or compress the cavernous sinus and thereby pick up feeding vessels from the cavernous carotid artery. Many authorities believe that JNA with such invasion are inoperable. These are often irradiated but then carry the attendant risk of the development of subsequent malignancy in adulthood. We have had experience with six patients who had tumors with central invasion that were treated by skull base surgery. The approaches, complications, and outcomes will be detailed in the presentation. Two patients had an incomplete resection. One refused further treatment and the second was treated with a course of irradiation. The remaining four had a complete resection and are tumor-free to this day with the longest follow-up being 25 years.