Combined Rhinosurgical and Neurosurgical Management of Intradural Angiofibromas

Abstract

Objectives: Although intracranial extension of angiofibromas is not uncommon, intradural penetration is rare. Management of such rare tumors is a challenging issue in skull base surgery, necessitating tumor removal via combined approaches in most cases. In this paper we present our experience for management of extensive intradural angiofibromas. Methods: Six cases were male patients, 5 between 15 and 19 years old, presenting with nasal obstruction and epistaxis and proptosis. One of them was an aggressive recurrent tumor in a 32-year-old patient. They were scheduled for combined approaches with assistance of image-guided endoscopic surgery. Results: Six cases underwent combined transnasal, tramaxillary, and craniotomy approaches with assistance of image-guided endoscopic surgery. Craniotomy preceded rhinologic approach in 3. CSF leak and skull base defect was repaired by temporalis muscle flap and pericranial flap in 4 and fascia lata in 2. One postoperative leak was repaired with fascia lata transcranially. Otherwise the course was uneventful in all cases. Conclusions: The intradural intracranial extensions of angiofibroma require meticulous approach in terms of surgery because of their greater risk for complications during the dissection. Carotid rupture and brain damage are 2 catastrophic complications which should be kept in mind. In cases with extensive intradural involvement of the middle cranial fossa by angiofibroma, craniotomy with intradural approach could help to decrease complications.