Pre-auricular Subtemporal Approach for Intracranial Angiofibroma

Document Type : Original

Authors

1 Department of Otorhinolaryngology Head and Neck Surgery, AIIMS, Guwahati, India.

2 Department of Otorhinolaryngology Head and Neck Surgery, NEIGRIHMS, Shillong, Meghalaya, India.

10.22038/ijorl.2024.74214.3496

Abstract

Introduction:
In around 10-20% of angiofibroma cases, the tumor penetrates the skull base to involve intracranial structures, posing difficulty in treating them surgically. Today, advancement in skull base surgery has brought about a paradigm shift, and extensive angiofibroma tumors with intracranial extension are approached surgically today with minimal morbidity.
Materials and Methods:
This study was a retrospective analysis of angiofibroma with significant intracranial extension Radkowski staging IIIb from 2011 to 2021 who came to our center. There were seven children of angiofibroma with significant intracranial extension Radkowski staging IIIb, out of whom, four patients had undergone surgical resection at our center. Three patients underwent surgery by pre-auricular lateral subtemporal approach and one patient by maxillary swing approach. Preoperative embolization was done in all the patients one day before the day of operation.
Results:
Gross total removal of the tumor was achieved in all three patients who had undergone pre-auricular lateral subtemporal approach with no permanent complication. All three patients had a minimum follow-up of one year with no recurrence.
Conclusion:
The pre-auricular lateral subtemporal approach provides the shortest shallow route to the affected skull base with direct visualization of the tumor base. Hence recommended for angiofibroma with Radkowski staging IIIb.  

Keywords

Main Subjects


  1. Liu ZF, Wang DH, Sun XC, Wang JJ, Hu L, Li H, et al. The site of origin and expansive routes of juvenile nasopharyngeal angiofibroma. Int. J. Pediatr. Otorhinolaryngol. 2011; 75: 1088–1092. doi: 10.1016/j.ijporl.2011.05.020.Epub 2011 Jun 29.
  2. Thakar A, Gupta G, Bhalla AS, Jain V, C Sharma S,  Sharma R, e t al.  Adjuvant therapy with flutamide for pre volume reduction in juvenile nasopharyngeal angiofibroma. Head Neck 33(12); 1747-1753, 2011. doi: 10.1002/ hed. 21667. Epub 2011 Jan 14.
  3. Kamel RH. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma. Journal of Laryngology and Otology1996;110(10):962–968. doi: 10.1017/s0022215100135467.
  4. Gołąbek W, Szymańska A, Szymański M, Czekajska-Chehab E, Jargiełło T. Juvenile nasopharyngeal angiofibroma with intracranial extension – diagnosis and treatment; Otolaryngol Pol 2019; 73 (1-7); doi: 10.5604/01. 3001.0013. 5275.
  5. Fisch U (1983): The infratemporal fossa approach for nasopharyngeal tumors. Laryngoscope, 93: 36-44. doi: 10.1288/00005537-198301000-00007.
  6. Fields JN, Halverson KJ, Devineni VR, Simpson JR, Perez CA. Juvenile nasopharyngeal angiofibroma: efficacy of radiation therapy. 1990 Jul;176(1):263-5. doi: 10.1148/ radiology. 176.1.2162070
  7. Shunyu NB, Gupta V, Thakar A: Complete resolution of stage IIIB juvenile nasopharyngeal angiofibroma with radiation therapy.Indian J. Otolaryngol. Head Neck Surg. (July–September 2008) 60:238–241. doi: 10.1007/s12070-008-0085-y.Epub 2008 Oct 22.
  8. Roche PH, Paris J, Regis J, et al. Management of invasive juvenile nasopharyngeal angiofibromas: the role of multimodality approach. Neurosurgery, 2007; 61: 768–777. doi: 10.1227/01. NEU. 0000298905. 71259.BB.
  9. P HermanG LotR ChapotD SalvanP T Huy. Long-term follow-up of juvenile nasopharyngeal angiofibromas: analysis of recurrences 1999 Jan;109(1):140-7. doi: 10.1097/ 00005537-199901000-00027.
  10. Sekhar LN, Moiler AR. Operative management of tumors involving the cavernous sinus. Journal of Neurosurgery 1986; 64: 879-889. doi: 10.3171/jns. 1986.64.6.0879.
  11. Chandler JR, Goulding R, Moscowitz L, Quencer RM. Nasopharyngeal angiofibromas : Staging and Management. Annals of Otology Rhinology Laryngology 1984; 93: 323-320 doi: 10.1177/ 000348948409300408.
  12. Mickey B, Close LG, Schaefer SD, Samson DA. combined frontotemporal and lateral infratemporal fossa approach to the skull base. Journal of Neurosurgery 1988; 68: 678-683. doi: 10.3171 /jns. 1988.68.5.0678.
  13. Andrews JC, Fisch U, Valavanis A, Aeppli U, Makek MS. The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. Laryngoscope 1989; 99:429–437. doi: 10.1288/00005537-198904000-00013.
  14. Danesi G, Panizza B, Mazzoni A, Calabrese V. Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension. Otola-ryngol Head Neck Surg. 2000;122(2):277-83. doi: 10.1016/S0194-5998(00)70256-7.
  15. Margalit N, Wasserzug O, De-Row A, et al. Surgical treatment of juvenile nasopharyngeal angiofibroma with intracranial extension. J.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neurosurg. Pediatrics, 2009; 4: 113–117. doi: 10. 3171/2009.4.PEDS08321.

  1. Elsharkawy AA, Kamal EM, Tawfik A, Zaher A, Kasem M. Juvenile nasopharyngeal angiofibroma

with intracranial extension: analysis of 23 Egyptian patients. Int. J. Ped. Otorhinolaryngol., 2010; 74: 755–759. doi: 10.1016/j.ijporl.2010.03.032. Epub 2010 Apr 14.

  1. Douglas R, Wormald Endoscopic surgery for juvenile nasopharyngeal angiofibroma: where are the limits? Curr Opin Otolaryngol Head Neck Surg.2006 Feb;14(1):1-5. doi: 10.1097/01. moo.0000188859. 91607.65.
  2. Donald PJ, Enepikedes D, Boggan J. Giant juvenile nasopharyngeal angiofibroma. Arch Otolaryngol Head Neck Surg. 2004;130:882–886. doi: 10.1001/archotol.130.7.882.
  3. Browne JD, Jacob SL. Temporal Approach for Resection of Juvenile Nasopharyngeal Angio- fibromas. Laryngoscope August 2000; 110(8): 1287-1293. doi:10.1097/00005537-200008000-00012.