The technique and results of the infratemporal fossa surgical removal of carcinomas and juvenile angiofibromas of the nasopharynx are presented. Effective palliative removal of T4 and radical removal of T1 and T2 nasopharyngeal carcinomas was achieved. A classification of juvenile nasopharyngeal angiofibroma is presented. The infratemporal fossa approach allows radical removal of type III tumors and subtotal removal of type IV tumors. If residual tumor has to be left back in the cavernous sinus, irradiation is used to stop further growth of the tumor. If radiotherapy fails the neurosurgical removal of the intracranial portion of the tumor is indicated.

Large juvenile nasopharyngeal angiofibromas are a therapeutic challenge because of their relation to major vasculature and cranial nerves at the base of the skull, and their propensity for recurrence. A classification scheme based on the growth pattern of this tumor is proposed to help the surgeon choose a procedure to access this lesion. This report describes the results obtained with the surgical removal of large (class III and IV) nasopharyngeal angiofibromas through the infratemporal fossa approach. Fourteen patients were cured and one individual developed a recurrence which was totally removed at a second procedure. Surgical morbidity was minimal and there was no mortality. Radiation therapy was necessary in only one patient who had tumor infiltration of the cavernous sinus.

IN spite of the translabyrinthine and middle cranial fossa approaches, tumours situated in the infralabyrinthine and apical regions of the pyramid and surrounding portions of the base of the skull remain a surgical challenge for neurosurgeons and otolaryngologists as well. The transpalataltranspharyngeal route proposed by Mullan et al. (1966) and the transcochlear approach of House and Hitselberger (1976) do not provide adequate exposure for large glomus jugulare tumours, clivus chordomas, cholesteatomas and carcinomas invading the pyramid tip and skull base. The proper management of these lesions requires a larger approach permitting exposure of the internal carotid artery from the carotid foramen to the cavernous sinus (Fig. 1). The infratemporal fossa exposure presented in this paper is a possible solution to this problem. The basic features of the proposed lateral approach to the skull base are: (a) the permanent anterior displacement of the facial nerve, (b) the subluxation or permanent resection of the mandibular condyle, (c) the temporary displacement of the zygomatic arch, and (d) the subtotal petrosectomy with obliteration of the middle ear cleft. Three different types of infratemporal fossa approach have developed from the experience gained in 51 patients. They will be described and illustrated with typical cases. Surgical technique

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