Skull Base 2007; 17 - A153
DOI: 10.1055/s-2007-984088

Surgical Treatment of Juvenile Nasopharyngeal Angiofibroma with Intracranial Involvement

Nevo Margalit 1(presenter), Oshri Wasserzug 1, Shimon Mimon 1, Sergei Spektor 1, Dan Fliss 1
  • 1Tel Aviv, Israel

Purpose: Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular tumor which occurs predominantly in adolescent males. Despite histologically benign features, up to 20% of patients may have skull base invasion or involvement of vital intracranial structures upon diagnosis. We report the surgical technique and outcome in seven patients with intracranial extension of JNA who underwent complete resection through a combined subcranial or a temporal-infratemporal approach.

Methods: A retrospective case series review was conducted. Seven consecutive patients' records were reviewed. All patients were treated in the Tel Aviv Medical Center by an interdisciplinary team. Preoperative intravascular embolization was performed in all seven patients. Four patients diagnosed with JNA extending to the middle fossa and cavernous sinus underwent excision of the tumor through a combination of a temporal craniotomy and a midfacial degloving approach. Three patients diagnosed with JNA extending to the anterior fossa underwent resection of the tumor via a combination of the subcranial and the midfacial degloving technique. Mean postoperative follow-up was 31 months, ranging from 17 to 59 months.

Results: Complete removal of the tumor was achieved in all seven patients. The cavernous sinus portion of the tumor was removed with no permanent morbidity. Postoperative complications included anesthesia at the V2 dermatomal distribution in four patients, anosmia in three patients, and late soft-tissue infection in one patient which resolved completely after 2 weeks of AB treatment. No other long-term sequels were recorded. To date, meticulous follow-up detected no clinical or radiological recurrence.

Conclusions: A combination of the subcranial or temporal with infratemporal and midfacial degloving approach is a viable and appropriate treatment option for JNA invading the intracranial space. Complete removal of the tumor with acceptable morbidity can be expected.