Pre-auricular Subtemporal Approach for Intracranial Angiofibroma

Introduction: In around 10-20% of angiofibroma cases, the tumor penetrates the skull base to involve intracranial structures, posing difficulty in treating them surgically. Today, advancement in skull base surgery has brought about a paradigm shift, and extensive angiofibroma tumors with intracranial extension are approached surgically today with minimal morbidity. Materials and Methods: This study was a retrospective analysis of angiofibroma with significant intracranial extension Radkowski staging IIIb from 2011 to 2021 who came to our center. There were seven children of angiofibroma with significant intracranial extension Radkowski staging IIIb, out of whom, four patients had undergone surgical resection at our center. Three patients underwent surgery by pre-auricular lateral subtemporal approach and one patient by maxillary swing approach. Preoperative embolization was done in all the patients one day before the day of operation. Results: Gross total removal of the tumor was achieved in all three patients who had undergone pre-auricular lateral subtemporal approach with no permanent complication. All three patients had a minimum follow-up of one year with no recurrence. Conclusion: The pre-auricular lateral subtemporal approach provides the shortest shallow route to the affected skull base with direct visualization of the tumor base. Hence recommended for angiofibroma with Radkowski staging IIIb.