Surgical management of nasopharyngeal angiofibroma with intracranial extension.

Intracranial extension of nasopharyngeal angiofibroma is a condition difficult to diagnose and even more difficult to treat. Often the diagnosis is not suspected until autopsy. The management of intracranial extension has included incomplete removal via the extracranial approach, radiation therapy, hormonal therapy and cryosurgery. The results of these therapeutic efforts have been characterized by persistent tumor, severe hemorrhage, intracranial complications and death. The combined intra-extracranial approach shows some promise of total tumor removal in the patient with intracranial extension with minimal morbidity. The general criteria of patient selection, risks, surgical technique and case histories of two patients are presented.