Resection followed by radiosurgery for advanced juvenile nasopharyngeal angiofibroma: Report of two cases

OBJECTIVE AND IMPORTANCE: Experience with the management of juvenile nasopharyngeal angiofibroma (JNA) by gamma knife radiosurgery is limited. We report control of the disease in two patients with advanced-stage JNA treated with primary resection followed by gamma knife stereotactic radiosurgery of residual disease. CLINICAL PRESENTATION: An 18-year-old man presented with chronic sinusitis, worsening headaches, diplopia, and left-sided facial numbness. A second patient, a 19-year-old man, presented with recurrent epistaxis and nasal congestion. Magnetic resonance imaging findings and endoscopic evaluation in each patient were consistent with advanced-stage JNA. INTERVENTION: One patient underwent craniofacial resection with approximately 3.0 cm³ of residual tumor in the region of the cavernous sinus. The other patient underwent preoperative embolization followed by a lateral rhinotomy for tumor resection with approximately 4.7 cm³ of residual tumor in the right infratemporal fossa. In an attempt to limit radiation to surrounding normal brain, residual tumor in both patients was treated with gamma knife stereotactic radiosurgery. Control of disease was documented by magnetic resonance imaging more than 24 months after treatment. CONCLUSION: Short-term control of late-stage JNA was achieved by use of a strategy of primary surgical resection followed by gamma knife radiosurgery of residual tumor in two patients. Establishing the effectiveness and safety of this strategy over conventional methods of managing advanced JNA will require future prospective studies.