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Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single‐stage rhinosurgical and neurosurgical approach
Author(s) -
Naraghi Mohsen,
Saberi Hooshang,
Mirmohseni Atefeh Sadat,
Nikdad Mohammad Sadegh,
Afarideh Mohsen
Publication year - 2015
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21507
Subject(s) - medicine , juvenile nasopharyngeal angiofibroma , infratemporal fossa , surgery , craniotomy , neurosurgery , cerebrospinal fluid leak , skull , cerebrospinal fluid , pathology
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.