UPDATE ON THE INFRATEMPORAL FOSSA APPROACHES TO NASOPHARYNGEAL ANGIOFIBROMA

Objectives: Review of preoperative evaluation, surgical management, an d outcome of patients operated on for nasopharyngeal angiofibroma usin g lateral infratemporal fossa approaches. Study Design: Retrospective review of 20 patients with either extensive (Fisch class IIa to IVb, n = 17) or less massive (Fisch class II, n = 3) nasopharyngeal angiofib romas. Analysis of preoperative radiologic classification and angiogra phy and description of indications and surgical techniques of the infr atemporal fossa approaches types C and D. Evaluation of the surgical m orbidity and radicality of tumor removal. Methods: Clinical data were obtained from medical records from 1987 to 1994. Tumor classification, preoperative symptoms type of surgery, and neuroradiologic and surgic al complications were evaluated. The completeness of tumor removal was assessed using postoperative magnetic resonance imaging. Results: Tem porary visual disturbance or headache, or both, was seen in two of 20 patients after superselective tumor embolization and further visual di minution was observed in one of six patients after balloon occlusion o f the internal carotoid artery. Radical resection was obtained in 80% of the cases. The infratemporal fossa type C approach was used in 16 o f the cases, with type D approaches used in the other four. There were no deaths. The major morbidity was the conductive hearing loss associ ated with the C approach. Conclusions: Preoperative embolization (and balloon occlusion in selected cases) remains an important adjunct with minimal morbidity. The lateral infratemporal fossa approaches yield a high rate of radical tumor removal (80%) and a low rate of recurrence (6%). If applicable, the type D approach avoids the conductive hearin g loss but allows direct tumor access into the infratemporal and ptery gopalatine fossae.