Intracranial Juvenile Nasopharyngeal Angiofibroma

Abstract

P a p a New GuineaEight cases of intracranial extensions of juvenile nasopharyngeal angiofibromas (JNA) are presented. These form 33% of the cases of JNA treated during a 5-year period . A high incidence of visual complications in this stage of tumour is observed and the basis of this is discussed. Death results from serious complications of severe haemorrhage and cerebro-spinal fluid leak. The intradural intracranial extensions of the tumour warrant careful approach in terms of surgery, because of their greater risk for complications during the dissection.

The Role of Radiation in the Treatment of Advanced Juvenile Angiofibroma

“… 7,8 Four routes to the cranium have been described in the literature from the tumor's point of origin at the posterolateral wall of the roof of the nasal cavity. 5,9,10 Tumor extension may occur 1 from the infratemporal fossa through the floor of the middle cranial fossa, 9 from the pterygomaxillary fissure and infratemporal fossa into the superior and inferior orbital fissures, 9 through direct erosion of the sphenoid sinus into the region of the sella turcica and cavernous sinus, 9,10 or more rarely, 4 along the horizontal lamina of the ethmoids and cribriform plate into the anterior cranial fossa. 10 Depending on which pattern of spread the tumor pursues, the growth will come to lie either lateral 1,2 or medial 3,4 to the cavernous sinus and internal carotid artery.…”

“… 10 Depending on which pattern of spread the tumor pursues, the growth will come to lie either lateral 1,2 or medial 3,4 to the cavernous sinus and internal carotid artery. 5,8,9 …”

Intermittent esotropia as the initial presentation of juvenile nasopharyngeal angiofibroma

“…Poorer outcomes are associated with more advanced expansion, and there have been case reports of intraoperative death because of these complications. 4 Thus, early diagnosis is paramount in achieving good outcomes with juvenile nasopharyngeal angiofibroma. As this case demonstrates, extension into the orbit and cavernous sinus can cause devastating vision loss, and ophthalmologists must be aware of this possibility.…”

Complete resolution of stage IIIB juvenile nasopharyngeal angiofibroma with radiation therapy

“…Our own experience with surgical treatment of intracranial extensions of angiofi broma has been safe but the literature reports of a reported mortality of at least 1 in 500 3 , and isolated reports have indicated a much higher mortality (20%) for advanced tumours with intracranial extension [15]. Further signifi cant morbidity includes life threatening hemorrhage [15,16], optic nerve injury [17], cranial nerve palsy [18], meningitis [15,18], risks related to general anaesthesia, angiography and blood transfusion with related problems. Thus from the experience of various authors, both form of therapy carry significant risk and fatal complications.…”