Juvenile nasopharyngeal angiofibroma with intracranial extension.

OBJECTIVE

To provide a critical evaluation of the historical evolution of the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) with intracranial extension.

STUDY DESIGN

Case series with chart review.

SETTING

Skull base multidisciplinary group at the Instituto de Neurologia de Curitiba, Brazil.

SUBJECTS AND METHODS

From 1988 to 2000, the multidisciplinary skull base group surgically treated 67 adolescent boys with JNA, 20 of whom presented with intracranial extension. All patients presented involvement of the cavernous sinus, and 5 of them spread into the orbit. Before 2008, the authors combined microscopic-endoscopic techniques. After this period, the surgical approach used was facial degloving, associated with purely endoscopic technique patients.

RESULTS

Total tumor removal was achieved in 17 cases in the first surgery. In this series, the intracranial extension was extradural in all cases. There was only 1 case of cerebrospinal fluid leakage, which was promptly identified and treated. There was no mortality or permanent morbidity.

CONCLUSION

Radical removal of large JNA may be difficult because of its extreme vascularity and extension to the cavernous sinus, orbit, middle and anterior fossa. Nevertheless, most of JNA with intracranial extension can be resected in the first operation with minimal morbidity through a facial degloving and further combination of expanded endoscopic endonasal approaches.