Huge nasopharyngeal angiofibroma with intracranial extension: change in the dura mater and choice of surgical management

2007 ◽  
Vol 121 (11) ◽  
pp. 1108-1112 ◽  
Author(s):  
ZX Yi ◽  
ZC Li ◽  
JM Cheng ◽  
R Zhang ◽  
Chang Lin ◽  
...  
Keyword(s):  
Surgical Management ◽  
Dura Mater ◽  
Sella Turcica ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Intracranial Tumour ◽  
Superior Orbital Fissure ◽  
Nasopharyngeal Angiofibroma ◽  
Cranial Fossa ◽  
Midfacial Degloving

AbstractWe aimed to review (1) the imaging changes in the dura mater in cases of huge, lobulated juvenile nasopharyngeal angiofibroma, and (2) the choice of surgical management.Imaging from four cases of juvenile nasopharyngeal angiofibroma showed extrapharyngeal extension of the tumour. The sphenoid sinus, sella turcica and clivus were extensively eroded, and the tumour had spread deep into the cranial fossa. In three cases, intracranial exploration was performed to treat the intracranial tumour lobule. Subsequently, the tumours were removed using extracranial approaches. No perforation of the dura mater was found in these three cases, although the dura mater in the superior orbital fissure was congested, haemorrhagic and solid. Pre-operative imaging for two cases (i.e. the first operation for one and the second operation for the other) revealed no dura mater perforation. A transantral approach via a midfacial degloving incision was used to remove these tumours completely.We conclude that change in the dura mater is a crucial indication for the choice of management. If the dura mater is intact, a transantral approach via a midfacial degloving incision may remove the tumour successfully.

Surgical treatment of juvenile nasopharyngeal angiofibroma with intracranial extension

2009 ◽  
Vol 4 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Nevo Margalit ◽  
Oshri Wasserzug ◽  
Ari De-Row ◽  
Avraham Abergel ◽  
Dan M. Fliss ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adjuvant Therapy ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Nasopharyngeal Angiofibroma ◽  
Cranial Fossa ◽  
Midfacial Degloving

Object The purpose of this study was to describe the surgical treatment and outcomes of patients with intracranial extension of juvenile nasopharyngeal angiofibroma (JNA). Methods Twenty-one patients who underwent operations for JNAs between 1994 and 2008 were enrolled in the study. Seven patients (33%) had intracranial tumor extension. The middle cranial fossa and cavernous sinus were involved in 4 patients who underwent operations via the combined infratemporal fossa-midfacial degloving approach. The anterior skull base was involved in 3 patients who underwent the subcranialmidfacial degloving approach. Results Complete tumor removal was achieved in all patients. Postoperative complications included 1 case of soft-tissue infection. None of the patients had tumor recurrence after a mean follow-up of 42 months (range 29–85 months). No adjuvant therapy was required in any patient. Conclusions Combined approaches can be used effectively for treatment of JNAs with intracranial extension without the need for adjuvant therapy.

Juvenile nasopharyngeal angiofibroma with intracranial extension – diagnosis and treatment.

2019 ◽  
Vol 73 (6) ◽  
Author(s):  
Wiesław Gołąbek ◽  
Anna Szymańska ◽  
Marcin Szymański ◽  
Elżbieta Czekajska-Chehab ◽  
Tomasz Jargiełło
Keyword(s):  
Infratemporal Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Radiological Findings ◽  
Superior Orbital Fissure ◽  
Nasopharyngeal Angiofibroma ◽  
Therapeutic Modalities ◽  
Stage Ivb ◽  
Extensive Involvement

Introduction This retrospective study analyzes radiological findings, therapeutic management and outcomes of patients with intracranial extension of juvenile nasopharyngeal angiofibroma (JNA). The routes of intracranial spread, incidence of intracranial disease and influence on therapeutic approach are discussed. Material and methods An evaluation on the records of 62 patients with JNA was performed and 10 patients with intracranial tumors were included in the study. All patients were males aged 10 to 19 years. Results According to Andrews' classification 8 patients presented with stage IIIb, 1 patient stage IVa and another patient stage IVb tumor. Intracranial invasion was extradural in 8 cases and intradural in 2 patient. Surgery was performed in 9 cases and the most common was combined approach: infratemporal fossa and sublabial transantral. One patient was referred for radiotherapy. Follow-up ranged from 8 to 26 years. There was extracranial recurrence in 2 (22%) of 9 operated patients. Conclusions The superior orbital fissure is the most frequent route of intracranial spread in patients with extensive involvement of the infratemporal fossa. Due to high risk of recurrence and potential serious complications advanced cases of JNA should be managed by experienced multidisciplinary team, preferably in tertiary referral centers, with an access to modern diagnostic and therapeutic modalities.

Removal of Intracranial Extension of Juvenile Nasopharyngeal Angiofibroma by the Transfacial Approach

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Philippe Herman ◽  
Romain Kania ◽  
Emmanuel Bayonne ◽  
Wissame Bakkourri ◽  
Patrice Tran Ba Huy
Keyword(s):  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Nasopharyngeal Angiofibroma

Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

2021 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Kristen M. Scheitler ◽  
Garret Choby ◽  
Jeffrey Janus ◽  
Eric J. Moore ◽  
...  
Keyword(s):  
Surgical Management ◽  
Intracranial Extension ◽  
Preoperative Embolization ◽  
Tumor Diameter ◽  
Historical Cohort ◽  
Nasopharyngeal Angiofibroma ◽  
Estimated Blood Loss ◽  
The Impact ◽  
Previous Series

Abstract Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures. Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center. Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort. Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.

Treatment of Large Juvenile Nasopharyngeal Angiofibroma

1992 ◽  
Vol 106 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Daniel G. Deschler ◽  
Michael J. Kaplan ◽  
Roger Boles
Keyword(s):  
Magnetic Resonance ◽  
External Carotid Artery ◽  
Magnetic Resonance Images ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
External Carotid ◽  
Nasopharyngeal Angiofibroma ◽  
Large Juvenile ◽  
Intracranial Disease ◽  
Preoperative Magnetic Resonance

The management of large juvenile nasopharyngeal angiofibromas with intracranial extension is controversial. We review our experience since 1980 with eighteen patients with juvenile nasopharyngeal angiofibroma. A diagnostic and treatment approach consisting of preoperative magnetic resonance imaging, embolization of feeding branches from the external carotid artery, and attempted complete resection was used in seven patients with intracranial disease since 1987. Serial magnetic resonance images were used for followup. Intracranial disease that was persistent or recurrent and demonstrated subsequent growth was irradiated (35 to 45 cGy). Extracranial tumor recurrences were reexcised. We advocate this approach as a safe and effective alternative to primary irradiation and its sequelae.

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