Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma With Extended Maxillectomy and Pterygopalatine Fossa Exposure.

Juvenile nasopharyngeal angiofibroma is a highly vascular skull base tumor in which complete endoscopic removal may be limited by restricted access to the pterygopalatine fossa and skull base attachment sites. We describe a standardized stepwise endoscopic strategy combining extended medial maxillectomy, complete posterior maxillary wall drilling, systematic exposure of the pterygopalatine fossa, and targeted drilling of bony tumor attachment sites. The technique was applied in 8 adolescent boys with Radkowski stage I-III disease following selective preoperative embolization. Creation of a single operative corridor facilitated early vascular control, direct visualization of the tumor origin, and complete resection. This innovation standardizes critical operative steps and may improve completeness of resection while maintaining the advantages of minimally invasive surgery. This standardized workflow may facilitate reproducible juvenile nasopharyngeal angiofibroma surgery while providing a framework for future comparative studies.