title: Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single-stage rhinosurgical and neurosurgical approach.
abstract: BACKGROUND
  Although intracranial extension of juvenile nasopharyngeal angiofibroma (JNA) occurs commonly, intradural penetration is extremely rare. Management of such tumors is a challenging issue in skull-base surgery, necessitating their removal via combined approaches. In this work, we share our experience in management of extensive intradural JNA.
  
  
  METHODS
  In a university hospital-based setting of 2 tertiary care academic centers, retrospective chart of 6 male patients (5 between 15 and 19 years old) was reviewed. Patients presented chiefly with nasal obstruction, epistaxis, and proptosis. One of them was an aggressive recurrent tumor in a 32-year-old patient. All cases underwent combined transnasal, transmaxillary, and craniotomy approaches assisted by the use of image-guided endoscopic surgery, with craniotomy preceding the rhinosurgical approach in 3 cases.
  
  
  RESULTS
  Adding a transcranial approach to the transnasal and transmaxillary endoscopic approaches provided 2-sided exposure and appreciated access to the huge intradural JNAs. One postoperative cerebrospinal fluid leak and 1 postoperative recurrence at the site of infratemporal fossa were treated successfully. Otherwise, the course was uneventful in the remaining cases.
  
  
  CONCLUSIONS
  Management of intracranial intradural JNA requires a multidisciplinary approach of combined open and endoscopic-assisted rhinosurgery and neurosurgery, because of greater risk for complications during the dissection. Carotid rupture and brain damage remain 2 catastrophic complications that should always be kept in mind. A combined rhinosurgical and neurosurgical approach also has the advantage of very modest cosmetic complications.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.|Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.|Rhinology Research Society, Tehran, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naraghi
authors.affiliation: Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hooshang
authors.initials: H
authors.lastname: Saberi
authors.affiliation: Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.|Rhinology Research Society, Tehran, Iran.
authors.forename: Atefeh Sadat
authors.initials: AS
authors.lastname: Mirmohseni
authors.affiliation: Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.|Rhinology Research Society, Tehran, Iran.
authors.forename: Mohammad Sadegh
authors.initials: MS
authors.lastname: Nikdad
authors.affiliation: Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.|Rhinology Research Society, Tehran, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Afarideh
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D059747:Nasal Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
keywords: angiofibroma; combined approach; intracranial approach; intradural approach; transnasal approach