Juvenile Nasopharyngeal Angiofibromas

Tumors of the skull base rarely affect children, but juvenile nasal angiofibroma represents a life-threatening entity owing to its invasive, destructive, highly vascular nature. The classic presentation is in an adolescent male with epistaxis or nasal obstruction, and pathogenesis is thought to be hormonally driven. Evaluation with nasal endoscopy and diagnostic imaging through CT, MRI, and angiography are critical to understand involvement of facial and skull base structures for multimodality operative planning. Coordinated interventions with preoperative angiographic embolization and combined endoscopic and open surgical approaches with otolaryngologists, oral and maxillofacial surgeons, and neurosurgeons are critical to effect the safe and effective removal of this potentially recrudescent lesion. Some small postoperative residuals may involute spontaneously, but for those that are considered persistent or prohibitively dangerous to resect, adjuvant radiotherapy is an effective option.