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The journal «ONCOSURGERY» 2012, Vol.4, No 4

The locally advanced craniofacial juvenile angiofibromas treatment tactics

Golbin DA, Cherekaev VA, Golanov AV, Kapitanov DN, Belov AI, Arustamian SR, Gromova VV, Imaev AA, Neresian MV, Galkin MV, Parshunina AM

FSI NN Burdenko Research Institute of Neurosurgery, RAMS, Moscow, Russia
Contact: Golbin DA, e-mail:

Introduction. Juvenile angiofibroma (JA) – is a rare benign tumor, occurring almost only in male-adolescents and young men. It is characterized with slow infiltrative growth, high vascularization and increased tendency to persistence and recurrence. The patients with intracranial tumors for surgical treatment is not always possible are challenging. The purpose of this study is to demonstrate the aspects of treating patients with the most challenging tumors.

Materials and methods. In the period from 2000 to 2011 in NN Burdenko Research Institute of Neurosurgery 47 male patients underwent surgery for angiofibromas stages III and IV by Fisch classification. The majority of patients had previous variable treatment. The main surgical principles were: preparation for the massive hemorrhage, preoperative embolization of the afferents, tumor removal through the orbitozygomatic extradural approach, complex plastic of the skull base. Endoscopic assistance was used in 21 cases.

Results. All patients underwent surgery, continued tumor growth occurred in 9 patients, then they were reoperated. Radiotherapy was performed in 6 patients. There were no deaths, non-life-threatening postoperative complications occurred in 15 cases. Two case reports of JA stage IV by Fisch are represented. Algorithms of treating for patients with tumors Fisch stage III, IV grades by Fish are demonstrated.

Conclusion. Surgical removal is the main concept of treatment for locally advanced JA. The usage of endoscopic assistance as an addition to the tumor resection through the orbitozygomatic approach, recommended by the authors is rational. Stereotaxic radiotherapy is indicated for case of impossibility of complete tumor removal, with efficacy for large residual tumor.

KEY WORDS: juvenile angiofibroma, craniofacial tumor, orbitozygomatic approach, endoscopy, stereotaxic radiotherapy.

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