J Korean Med Sci.  2006 Aug;21(4):773-777. 10.3346/jkms.2006.21.4.773.

Recurrent Juvenile Nasopharyngeal Angiofibroma Treated with Gamma Knife Surgery

• Park CK
• Kim DG
• Paek SH
• Chung HT
• Jung HW

• KMID: 2157839
• DOI: http://doi.org/10.3346/jkms.2006.21.4.773

Abstract

Radiosurgery has been rarely applied for juvenile nasopharyngeal angiofibroma (JNA) and cumulative reports are lacking. The authors report a case of successful treatment of recurred JNA with gamma knife surgery (GKS). A 48-yr-old man was presented with right visual acuity deterioration and brain magnetic resonance images (MRI) disclosed a 3 cm-sized intraorbital mass in the right orbit. He underwent a right fronto-temporal craniotomy and the mass was subtotally removed to preserve visual function. Histological diagnosis confirmed JNA in typical nature. However, the vision gradually worsened to fail four years after operation. MRI then showed regrowth of the tumor occupying most of the right orbit. GKS was done for the re-curred lesion. A dose of 17 Gy was delivered to the 50% isodose line of tumor mar-gin. During the following four-year follow-up period, the mass disappeared almost completely without any complications. Usually JNA can be exclusively diagnosed by radiological study alone. So this report of successful treatment of JNA with GKS may provide an important clue for the novel indication of GKS.

Keyword

Radiosurgery; Gamma Knife Radiosurgery; Angiofibroma; Juvenile Nasopharyngeal Angiofi-broma; Treatment Outcome

MeSH Terms

Visual Acuity
Treatment Outcome
Radiosurgery/*methods
Neoplasm Recurrence, Local
Nasopharyngeal Neoplasms/diagnosis/*surgery
Middle Aged
Male
Magnetic Resonance Imaging
Humans
Brain/radiography
Angiofibroma/diagnosis/*surgery
Adolescent

Figure

• 

  Fig. 1 Preoperative axial Gd-DTPA-enhanced T1-weighted magnetic resonance image (A) demonstrating homogeneously enhancing mass in the right orbit. This mass was subtotally removed with small residual remaining in the orbital cone as postoperative computed tomography shows (B).

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  Fig. 2 Histopathological appearance of juvenile nasopharyngeal angiofibroma. Note typical feature of dense fibro-colllagenous tissue with interspersed slit-like and gaping vascular channels (H&E, ×45).

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  Fig. 3 Axial (A) and sagittal (B) Gd-DTPA-enhanced T1-weighted magnetic resonance images obtained four years after the initial surgery. Multilobulated homogeneously enhancing recurrent mass in the right orbit extending to the inferior orbital fissure and cavernous sinus is shown.

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  Fig. 4 Axial Gd-DTPA-enhanced T1-weighted magnetic resonance image showing dose distribution for gamma knife surgery. Total volume is measured 6.8 cm3. A dose of 17 Gy was delivered to the 50% isodose line of tumor margin.

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  Fig. 5 Serial follow-up Gd-DTPA-enhanced T1-weighted magnetic resonance images after gamma knife surgery. Gradual decrease in size of the mass is noted after a year with total volume of 2.2 cm3 (A) and two years with 0.97 cm3 (B), and finally disappeared four years after the gamma knife surgery (C).

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