Abstract
Advanced juvenile angiofibromas (JA) are challenging tumors to treat surgically due to the involvement of skull base structures and vascularity derived from the intracranial circulation. Tumor infiltration of the pterygoid base encompasses the pterygoid canal and derives blood supply from branches of the internal carotid artery (ICA), most commonly the vidian artery and branches from the cavernous segment. Large tumors may surround the petrous and cavernous segments of the ICA and increase the risk of vascular injury during surgery.
With proper planning, large juvenile angiofibromas with intracranial extension can be managed using endoscopic techniques. The biggest challenges are bleeding from tumor vessels derived from the intracranial circulation. The UPMC staging system is useful in devising a surgical strategy based on the degree of residual vascularity and the route of intracranial extension. A staged approach with excision of vascular territories of the tumor allows safe resection with minimal morbidity. There is a higher risk of residual tumor with advanced juvenile angiofibroma with skull base involvement, but not all patients require further surgery. Radiation therapy can be avoided with a comprehensive surgical strategy.
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Snyderman, C.H., Gardner, P.A., Fernandez-Miranda, J.C., Wang, E.W. (2017). Endoscopic Excision of Advanced Tumor with Skull Base Involvement. In: Dubey, S., Schick, B. (eds) Juvenile Angiofibroma. Springer, Cham. https://doi.org/10.1007/978-3-319-45343-9_12
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DOI: https://doi.org/10.1007/978-3-319-45343-9_12
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