Staging and surgical approaches in large juvenile angiofibroma—Study of 95 cases

Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension

“…Small type I and type II tumors have been removed via a transpalatal [9], midfacial degloving [10] or endoscopic approaches [11]. Type IIIa tumors, with infratemporal fossa or orbital involvement but without intracranial involvement, have been classically resected via a combined transpalatal and transmaxillary approaches [12], endoscopic assisted midfacial degloving approach [13] or the infratemporal fossa approach advocated by Fisch [5]. An adjuvant second endoscopic approach through the anterior wall of the maxillary sinus has been reported whenever the lateral extension of the angiofibroma within the pterygomaxillary fossa could not be completely visualized and controlled only by the transnasal endoscopic approach [14].…”

“…Moulin et al [16] showed a mean blood loss of 5380 cm 3 in nonembolized patients versus 1037.5 cm 3 in embolized patients. Tyagi et al [12] reported a range of 1500 cm 3 of blood loss in large angiofibroma using a combined transpalatal and transmaxillary approach with preoperative embolization. El-Banhawy et al [13] reported an average blood loss of 500 cm 3 with embolization and 1000 cm 3 without embolization using an endoscopic assisted midfacial degloving approach for type III JNA.…”

“…Opponents of the technique stress on the rare complications such as cerebral infarcts and vision loss which are generally secondary to abnormal collaterals from the internal maxillary artery to the intracranial and intraorbital contents [18]. On the contrary, most of the surgeons agree that preoperative embolization is a safe and effective procedure which should be performed but with an experienced radiologist [11,12,16,19]. Detailed assessment of the possible dangerous collaterals by superselective microcatheterization of the dangerous collaterals should be performed to avoid major complications [20].…”

“…El-Banhawy et al [13] reported 13.5% recurrence using endoscopic assisted midfacial degloving in 15 patients of type III JNA. Tyagi et al [12] described 13.8% residual tumor in 65 cases of type IIIa JNA using a combined transpalatal and transmaxillary approach.…”

Juvenile nasopharyngeal angiofibroma: current treatment modalities and future considerations

“…8 [27,28]. The frontotemporal craniotomy approach is used in stage IVA tumors according to Andrew et al classification [12,29].…”