Management of juvenile angiofibromata

Twenty-eight angiofibromata, treated between 1971 and 1988, were reviewed according to their patterns of invasion, blood supply, treatment modality, and clinical course. All patients were males, and two patients were black. The average age was 14.8 years. Nasopharyngeal masses, epistaxis, and facial asymmetry were the most common presenting symptoms. Tumors extended along predetermined pathways following the vascularity of the external carotid system. CNS extension arose via the superior orbital fissure or direct extension from the sphenoid sinus. Angiography described the neoplastic vascularity, CT with contrast demonstrated tumor location and extracranial extension, and MRI best demonstrated CNS invasion. All lesions were reclassified according to the American Joint Committee staging system. Twenty-seven patients were operated upon; four with cryotherapy and 23 following embolization. Two tumors recurred and needed additional surgery. One patient with CNS invasion was treated with estrogen and radiotherapy for cure. Tumor staging is not particularly helpful in decision making, because surgery must be individualized according to tumor location and extent. Surgical approaches for specific tumor locations are discussed.