Endoscopic management of advanced juvenile nasopharyngeal angiofibroma with extensive infratemporal fossa extension: surgical challenges and technical modifications- case report

Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign yet locally invasive vascular tumour affecting adolescent males. Advanced tumours extending into the infratemporal fossa (ITF) pose significant surgical challenges. Case report An 11-year-old boy presented with a one-year history of progressive left-sided proptosis and a two-month history of left cheek swelling. Imaging revealed a highly vascular mass centred in the left sphenopalatine fossa, extending into the infratemporal fossa, orbit, nasopharynx, cavernous sinus, and extradural temporal lobe. Preoperative embolisation was performed to reduce intraoperative blood loss. The tumour was completely excised via a transnasal endoscopic approach with few modifications. The postoperative course was uneventful, and follow-up imaging at two months demonstrated no residual disease. Histopathology confirmed JNA. Conclusion This case demonstrates that exclusive endoscopic transnasal excision, combined with preoperative embolisation, can achieve complete resection of advanced JNA with extensive ITF extension, avoiding morbid open approaches.