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Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single-stage rhinosurgical and neurosurgical approach

International forum of allergy & rhinology, 2015-07, Vol.5 (7), p.650-658 [Peer Reviewed Journal]

2015 ARS‐AAOA, LLC ;2015 ARS-AAOA, LLC. ;2015 ARS-AAOA, LLC ;ISSN: 2042-6976 ;EISSN: 2042-6984 ;DOI: 10.1002/alr.21507 ;PMID: 25778926

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Title:
Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single-stage rhinosurgical and neurosurgical approach
Author: Naraghi, Mohsen ; Saberi, Hooshang ; Mirmohseni, Atefeh Sadat ; Nikdad, Mohammad Sadegh ; Afarideh, Mohsen
Subjects: Adolescent ; Adult ; angiofibroma ; Angiofibroma - surgery ; combined approach ; Craniotomy - adverse effects ; Craniotomy - methods ; Endoscopy ; Humans ; intracranial approach ; intradural approach ; Male ; Nasal Surgical Procedures - adverse effects ; Nasal Surgical Procedures - methods ; Nasopharyngeal Neoplasms - surgery ; Natural Orifice Endoscopic Surgery - adverse effects ; Natural Orifice Endoscopic Surgery - methods ; Retrospective Studies ; transnasal approach ; Young Adult
Is Part Of: International forum of allergy & rhinology, 2015-07, Vol.5 (7), p.650-658
Description: Background Although intracranial extension of juvenile nasopharyngeal angiofibroma (JNA) occurs commonly, intradural penetration is extremely rare. Management of such tumors is a challenging issue in skull‐base surgery, necessitating their removal via combined approaches. In this work, we share our experience in management of extensive intradural JNA. Methods In a university hospital–based setting of 2 tertiary care academic centers, retrospective chart of 6 male patients (5 between 15 and 19 years old) was reviewed. Patients presented chiefly with nasal obstruction, epistaxis, and proptosis. One of them was an aggressive recurrent tumor in a 32‐year‐old patient. All cases underwent combined transnasal, transmaxillary, and craniotomy approaches assisted by the use of image‐guided endoscopic surgery, with craniotomy preceding the rhinosurgical approach in 3 cases. Results Adding a transcranial approach to the transnasal and transmaxillary endoscopic approaches provided 2‐sided exposure and appreciated access to the huge intradural JNAs. One postoperative cerebrospinal fluid leak and 1 postoperative recurrence at the site of infratemporal fossa were treated successfully. Otherwise, the course was uneventful in the remaining cases. Conclusion Management of intracranial intradural JNA requires a multidisciplinary approach of combined open and endoscopic‐assisted rhinosurgery and neurosurgery, because of greater risk for complications during the dissection. Carotid rupture and brain damage remain 2 catastrophic complications that should always be kept in mind. A combined rhinosurgical and neurosurgical approach also has the advantage of very modest cosmetic complications.
Publisher: United States: Blackwell Publishing Ltd
Language: English
Identifier: ISSN: 2042-6976
EISSN: 2042-6984
DOI: 10.1002/alr.21507
PMID: 25778926
Source: MEDLINE
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Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single-stage rhinosurgical and neurosurgical approach

2015 ARS‐AAOA, LLC ;2015 ARS-AAOA, LLC. ;2015 ARS-AAOA, LLC ;ISSN: 2042-6976 ;EISSN: 2042-6984 ;DOI: 10.1002/alr.21507 ;PMID: 25778926

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