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 imageguided 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.