Treatment of Giant Nasopharyngeal Angiofibroma with Intracranial Growth: An Interdisciplinary Approach

A.V. Shcherbinin, D.A. Gulyaev, N.N. Nikolaenko, I.A. Tikhomirova

(Polenov Research Neurosurgical Institute, Saint Petersburg
Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg)

Juvenile nasopharyngeal angiofibromas are benign neoplasms with abundant blood supply, which are prone to extensive growth. The main method of treatment is a surgical intervention. These angiofibromas can relapse in case of incomplete removal.

Male patient M., aged 16, was admitted to the clinic of the Research Institute of Otorhinolaryngology with complaints of impaired nasal breathing, repeated nasal bleeding, headaches of a meningeal-vascular character in temporal areas. MRI examination demonstrated a giant neoplasm of the ethmoidal labyrinth, sphenoid sinus, left maxillary sinus. The tumor caused destruction of the cribriform plate and spread intracranially. Carotid angiography revealed a vast vascular network of the tumor. A system of the maxillary artery was the main source of blood supply.

Superselective embolization was performed in the First Children’s Municipal Hospital on January 10, 2004. Operation was made on January 12, 2004, using a combined approach. It consisted in bifrontal osteoplatic trephination of the skull, removal of the tumor with applying an anterior transbasal approach (Derom), plasty of the posterior cranial fossa with a periosteal transplant. The team of ENT-surgeons was responsible for removing the tumor from the maxillary sinus and lower nasal passage; a sublabial approach was used.

A postoperative course was uneventful. Healing by first intention was observed. There was no postoperative liquorrhea. Control MRI examination demonstrated no tumor tissue.

The demonstration goal was to inform about potentialities of a complex interdisciplinary approach to treatment of juvenile pharyngeal angiofibromas with intracranial growth.