Juvenile nasopharyngeal angiofibroma: Management of intracranial extension

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign, locally invasive tumor of the nasopharynx that is found primarily in the pubescent male. While most authors recommend surgical excision for smaller, localized extracranial tumors, opinion varies on the management of more aggressive tumors with intracranial extension. The authors present their experience over the past 15 years with 15 cases of JNA with intracranial extension, and formulate a plan of management. A combined otolaryngologic/neurosurgical approach is recommended in order to assess the extent of the tumor and to isolate feeding vessels. Lateral extension into the middle cranial fossae should be resected in continuity with the nasopharyngeal component, which is approached from below in a separate operative field. Medial extensions are transected, verified angiographically three months after surgery, and irradiated. The results of therapy are presented, and a case of dural penetration by JNA is described.

Nasopharyngeal Angiofibroma-changing Trends in the Management

“…With the advent of newer diagnostic methods it is prudent that intracranial extensions are much more common than initially believed, and reported in as many as 10-30% of cases [12]. Majority of theses intracranial extensions are extradural and only few reports are available in the literature regarding intradural extension [13].…”

Nasopharyngeal angiofibroma with cavernous sinus involvement — An unusual presentation

“…Its incidence has been stated to be as low as one in 50,000 otolaryngological new patients (Chandler et al, 1984). Intracranial extension has been observed in 20-30% patients with JNA (Jafek et al, 1979;Cummings et al 1984).…”

Complete resolution of stage IIIB juvenile nasopharyngeal angiofibroma with radiation therapy

“…Although benign, the tumor may exhibit locally aggressive behaviour, eroding into adjacent structures and causing functional injury [1,2]. Intracranial involvement has been reported to occur in 10-30 % of all cases with middle cranial fossa being the most common sites of intracranial extension [3,4]. Significant morbidity and even death may occur from intra cranial extension or haemorrhage [5].…”

“…Surgery is the treatment of choice for lesions without intracranial extension but therapeutic management of JNA with intracranial extension still remains controversial [4,6]. While some opine that such tumors can be safely resected, others argue that radiotherapy signifi es the best form of treatment for such tumors.…”

“…While some opine that such tumors can be safely resected, others argue that radiotherapy signifi es the best form of treatment for such tumors. Both, either surgery or radiotherapy have been reported to achieve a control rate of 80% [4,6]. Some surgeons even advocate partial resection and follow by radiating the residual tumour [7].…”