Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma

Review of preoperative evaluation, surgical management, and outcome of patients operated on for nasopharyngeal angiofibroma using lateral infratemporal fossa approaches.

Retrospective review of 20 patients with either extensive (Fisch class IIIa to IVb, n = 17) or less massive (Fisch class II, n = 3) nasopharyngeal angiofibromas. Analysis of preoperative radiologic classification and angiography and description of indications and surgical techniques of the infratemporal fossa approaches types C and D. Evaluation of the surgical morbidity and radicality of tumor removal.

Clinical data were obtained from medical records from 1987 to 1994. Tumor classification, preoperative symptoms, type of surgery, and neuroradiologic and surgical complications were evaluated. The completeness of tumor removal was assessed using postoperative magnetic resonance imaging.

Temporary visual disturbance or headache, or both, was seen in two of 20 patients after superselective tumor embolization, and further visual diminution was observed in one of six patients after balloon occlusion of the internal carotid artery. Radical resection was obtained in 80% of the cases. The infratemporal fossa type C approach was used in 16 of the cases, with type D approaches used in the other four. There were no deaths. The major morbidity was the conductive hearing loss associated with the type C approach.

Preoperative embolization (and balloon occlusion in selected cases) remains an important adjunct with minimal morbidity. The lateral infratemporal fossa approaches yield a high rate of radical tumor removal (80%) and a low rate of recurrence (6%). If applicable, the type D approach avoids the conductive hearing loss but allows direct tumor access into the infratemporal and pterygopalatine fossae.