Gamma Knife Radiosurgery for Advanced and Recurrent Juvenile Nasopharyngeal Angiofibroma: A Case Series

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, but locally aggressive tumor that typically affects adolescent males. While surgical resection is the standard treatment, achieving total resection is often challenging in advanced-stage tumors with intracranial extension, resulting in high recurrence rates. Gamma knife radiosurgery (GKRS) has been suggested as a potential adjuvant or salvage therapy, but evidence remains limited. In this study, we report three pediatric cases of advanced-stage JNA treated with GKRS following incomplete surgical resection. Two patients demonstrated durable local tumor control with a significant reduction in tumor size until 2 and 12 years after GKRS. The other patient with partial coverage of tumor by prescription isodose 12 Gy showed a reduction of tumor volume at 6 months but subsequent progression at 1 year. No GKRS-related complications were observed during the follow-up period. Our findings suggest that GKRS appears to be a potentially safe and effective treatment modality for residual or recurrent JNAs. Fractionated or staged GKRS combined with surgery may be a preferable strategy for large tumors in which extensive surgery alone, conventional radiotherapy, or single-fraction radiosurgery may be associated with increased morbidity in pediatric populations.