2026 Poster Presentations
P189: JUVENILE NASOPHARYNGEAL ANGIOFIBROMA WITH SKULL BASE INVOLVEMENT. EXPERIENCE AT INSTITUTO DE NEUROCIRUGÍA DR. ALFONSO ASENJO.
Matias Gomez, MD1; Marina Pizarro, MD2; Jose Manuel Zuñiga, MD2; Cristian Naudy, MD3; Francisca Montoya, MD4; 1Instituto de Neurocirugía Dr Asenjo, Clinica Alemana; 2Hospital del Salvador; 3Instituto de Neurocirugía Dr Asenjo; 4Hospital de Villarrica
Background: Juvenile nasopharyngeal angiofibromas (JNA) are benign but locally aggressive fibrovascular tumors that predominantly affects adolescent males. Although histologically non-malignant, advanced stages often present with skull base involvement and intracranial extension, posing a significant surgical challenge due to complex anatomical extension, significant vascularity, and potential morbidity. Advances in surgical techniques, particularly the endoscopic endonasal approach (EEA), have broadened treatment options, yet controversy persists regarding the optimal management of tumors with extensive skull base and intracranial invasion.
Objective: This study aimes to describe the surgical experience of al Latin American high-volumne referral center in managing advanced-stage JNA with skull base involvement while highlighting the most common anatomical routes of tumor dissemination relevant for surgical planning.
Methods: A retrospective review was conducted of patients with histologically confirmed JNA treated surgically between January 2017 and January 2022 at the Instituto de Neurocirugía Dr. Alfonso Asenjo (INCA), Chile. Inclusion criteria were patients with advanced disease (Radkowsky stages IIIA and IIIB) with evidence of skull base involvement. Clinical records preoperative imaging (CT and MRI), surgical approach, intraoperative findings, complications, and postoperative outcomes were analyzed. Early postoperative MRI (within 24-48 hours) was used to assess the extent of resection and presence of residual disease. Descriptive statistical analysis was performed.
Results: Nine male patients were included, with a mean age of 14.8 years (range of 10 to 28 years). Five patients were staged as Radkowski IIIA (55.5%) and four as IIIB (44.4%). All patients demonstrated skull base involvement, most frequently via the sphenoid sinus (100%) and palatovaginal canal (100%), followed by the by the vidian canal (88.8%). Intracranial dissemination through the superior orbital fissure and middle cranial fossa occurred in 33% of cases each. All patients underwent preoperative embolization. Eight patients were treated using an exclusive EEA, while one required a combined endoscopic and transoral approach. Intraoperative blood loss ranged from 100 to 1300 ml. Early postoperative MIRA revealed residual disease in 4 patients, all staged IIIB. Two of these underwent staged resection through open approaches, one was lost to follow-up, and one remains under surveillance. No late postoperative complications were reported.
Conclusion: Advanced JNA with skull base and intracranial involvement presents significant surgical challenges. Detailed preoperative imaging is essential to identify dissemination routes and tailor the surgical approach. While EEA enables safe and effective resection in most cases, combined or open techniques remain necessary in patients with extensive intracranial disease. Multidisciplinary collaboration and precise anatomical knowlegde are critical for optimizing outcomes in this complex patient population.
