The combined subtemporal-transfacial approach for the resection of juvenile nasopharyngeal angiofibromas with intracranial extension

Objective: Stage IVb juvenile nasopharyngeal angiofibromas (JNAs) are frequently regarded as unresectable because of their intracranial extension and cavernous sinus invasion. Although radiation has been described to control these tumors, it can leave the adolescent with long-lasting sequelae. Herein, we describe an alternative treatment strategy based on a combined subtemporaltransfacial surgical approachthat permits the successfulmanagement of advanced stage JNAsby divorcing the intracranial vascular supply to these massive lesions.

Patients: Four male patients were identified with Andrew's Stage IVB JNAs. Intervention: All patients were treated by surgical resection using a combined subtemporal-transfacial surgical approach.

Main Outcome Measures: Parameters assessed included tumor extent, number and types of surgical procedures, extent of resections, complications, and recurrence rate.

Results: Near-total tumor resections were achieved in all patients. No cerebrospinal fluid leak or cranial neuropathies were noted. All but one patient had local recurrences, and these could be managed with repetitive endoscopic debridement. No patient required adjuvant radiation treatment to control advanced disease. Conclusions: With the use of modern skull base surgical techniques, coordinated interdisciplinary care, and safe, near-total removal of the tumor mass, adolescent males with advanced JNAs may be spared the long-term morbidities associated with using radiation to treat these benign but aggressive lesions.