title: [Surgical treatment of children presenting with juvenile angiofibroma of the skull base].
abstract: A total of 475 children have been operated at the Russian Children's Clinical Hospital during the last 20 years for the removal of benign and tumour-like neoplasms localized mostly in the nasal cavity, paranasal sinuses, and nasopharynx. As many as 361 (76%) of these patents were found to have juvenile angiofibroma of the base of the skull. In most of them, the tumour was diagnosed at the late stages of development. Accordingly, the scarcity and non-specific character of early clinical manifestations of the disease taken together with complicated topographic anatomy of angiofibromas and the difficulty of detailed visualization of the affected zone in young children account for their late hospitalization. The angiomatous lesions prevailed in the spheno-ethmoidal and basiliar regions. The children were operated through the nasomaxillary approach as described by Denker (in V.S. Pogosov's modification) without ligation of external carotid arteries. Since 1996, surgery has been performed after endovascular occlusion of the vessels feeding the tumour, with the maximally possible sparing of bone structures and taking into account the continuing active growth and formation of the facial skeleton. Relapses were documented in 43 (12%) patients. Postoperative radiotherapy had to be applied in the children showing recurrent growth of the tumour or its intracranial extension and in the cases when radical removal of the tumour proved impracticable because of its localization in the vitally important anatomical regions.
mesh_terms: D000293:Adolescent; D018322:Angiofibroma / Q000532:radiotherapy / Q000601:surgery*; D000798:Angiomatosis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D009364:Neoplasm Recurrence, Local; D019292:Skull Base Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome