Juvenile angiofibromas. Behavior and treatment of extensive and residual tumors

In a 15-year period, 40 juvenile angiofibromas were treated surgically (lateral or extended rhinotomy) at the Mayo Clinic, Rochester, Minn. Tumors were staged according to size and extension by using the Sessions classification. Stage III tumors involved the middle fossa or cavernous sinus or both structures, with or without extension into the orbit. Seven patients had stage I, ten had stage IIA, and six had stage IIB disease. Five tumors extended to the skull base (stage IIC). There were 12 cases that included intracranial extension (stage III), none of which involved the sella. There were eight cases with residual tumor: four (stages IIB [one], IIC [one], and III [two]) were not treated again, and four (stage III) were treated with various methods, including operation, embolization, and irradiation. No patient died. No complications or morbidity was experienced by the four patients who were not treated for residual tumor.