Juvenile angiofibroma: the lessons of 20 years of modern imaging

Seventy-two patients with juvenile angiofibroma have been investigated by c omputerized tomography (CT) and/or magnetic resonance imaging (MRI) over a period of 20 years. The evidence from these studies indicates that angiofib roma takes origin in the pterygo-palatine fossa at the aperture of the pter ygoid (vidian) canal. An important extension of the tumour is posteriorly a long the pterygoid canal with invasion of the cancellous bone of the pteryg oid base, and greater wing of the sphenoid (60 per cent of patients). Disti nctive features of angiofibroma are the high recurrence rate, and the rapid ity with which many tumours recur. It is postulated that the principal dete rminant of recurrence is a high tumour growth rate at the time of surgery c oupled with incomplete surgical excision. The inability to remove the tumou r in tote is principally due to deep invasion of the sphenoid, as described above. In this series 93 per cent of recurrences occurred with this type o f tumour extension. A contributory cause in these patients is the use of pr e-operative embolization. The treatment implications of these findings are examined.