NASOPHARYNGEAL ANGIOFIBROMAS - SELECTING A SURGICAL APPROACH

Background: A review of 16 juvenile nasopharyngeal angiofibromas, mana ged at the University of Pittsburgh, is presented. Methods. A retrospe ctive chart review was done. Surgical approaches and factors affecting recurrence are analyzed. Results. Endoscopic transnasal, transpalatal , medial maxillectomy, facial translocation, and intratemporal fossa a pproaches, with or without craniotomy, were employed. The 37.5% recurr ence rate reflects the advanced stage of the tumors. A major risk fact or for recurrence was tumor involvement of the cranial base. Conclusio ns. The surgical approach should be selected according to tumor locati on and effectiveness of embolization. In young patients, the approach should minimize the potential for facial growth retardation. Tumors co nfined to the nasopharynx, nasal cavity, and paranasal sinuses may be removed endoscopically. Medial maxillectomy is recommended for tumors that extend to the medial intratemporal fossa or medial cavernous sinu s. Significant involvement of the infratemporal fossa, cavernous sinus , or middle cranial fossa requires intratemporal fossa or transfacial approaches. (C) 1997 John Wiley & Sons, Inc.