{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:50:00Z","timestamp":1786125000423,"version":"build-2736575974"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p>\n                    Juvenile angiofibroma is a rare benign expansive lesion typically affecting young men. Surgery is the current mainstay of treatment. Because it is a very vascular lesion, preoperative transarterial embolization can decrease intraoperative bleeding.\n                    <jats:sup>1,2<\/jats:sup>\n                    Transmaxillary or transpalatal approaches were used for totally extracranial lesions. Endonasal endoscopic resection became wildly used for radical excision with limited morbidity.\n                    <jats:sup>2<\/jats:sup>\n                    In large lesions with intracranial extension and cavernous sinus involvement (Fisch type 4), purely anterior approaches (endoscopic or transmaxillary) can be associated with significant carotid artery and cranial nerves injuries and excessive hemorrhage from internal carotid artery supply that cannot be eliminated by preoperative embolization.\n                    <jats:sup>3<\/jats:sup>\n                    Subtotal resection has been preconized in such cases, but tumor progression, cranial nerves and vision compromise, and major nasal postoperative bleeding could ensue. Radiotherapy of residual tumor has been associated with long-term complications, particularly given the young age of these patients.\n                    <jats:sup>2<\/jats:sup>\n                    The cranio-orbital zygomatic approach provides an excellent exposure to the extensions into the middle fossa, anterior fossa, cavernous sinus, paranasal sinus, and infratemporal fossa components of large angiofibromas.\n                    <jats:sup>4\u20136<\/jats:sup>\n                    It is particularly advantageous in the early interruption of the cavernous carotid feeders that are not amenable to safe embolization, rendering the tumor devascularized and bloodlessly resected. This article demonstrates the details and the advantages of this approach in a 13-year-old adolescent boy operated in 1997 for giant juvenile angiofibroma with extension in the middle fossa and the parasellar space with major vascularization from the cavernous carotid artery. The guardian consented to the procedure and publication of images.\n                  <\/jats:p>\n                  <jats:p>\n                    Image at 3:05 reprinted with permission from Al-Mefty O,\n                    <jats:italic toggle=\"yes\">Operative Atlas of Meningiomas.<\/jats:italic>\n                    Vol 1, \u00a9 LWW, 1998. Image at 3:25 from Arnautovi\u0107 KI, Al-Mefty O, Angtuaco E. A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms.\n                    <jats:italic toggle=\"yes\">Surg Neurol<\/jats:italic>\n                    . 1998;50(6):504-520; \u00a9 Elsevier, 1998. Used with permission. Image at 9:21 reprinted from Kempe LG and Krekorian EA,\n                    <jats:sup>6<\/jats:sup>\n                    with permission from John Wiley and Sons, \u00a9 1969 The Triological Society.\n                  <\/jats:p>","DOI":"10.1227\/ons.0000000000000008","type":"journal-article","created":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T13:01:29Z","timestamp":1639573289000},"page":"e44-e45","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["The Utilization of the Cranio-Orbital Zygomatic Approach for the Resection of Juvenile Nasopharyngeal Angiofibroma: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"22","author":[{"given":"Antonio","family":"Aversa","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, National Institute of Cancer, Rio de Janeiro, Brazil;"},{"name":"Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"issue":"5","key":"R1-20250821","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1097\/00006123-199905000-00008","article-title":"Benign nonmeningeal tumors of the cavernous sinus","volume":"44","author":"Eisenberg","year":"1999","journal-title":"Neurosurgery."},{"issue":"1","key":"R2-20250821","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/MOO.0000000000000505","article-title":"Contemporary management of juvenile angiofibroma","volume":"27","author":"Bertazzoni","year":"2019","journal-title":"Curr Opin Otolaryngol Head Neck Surg."},{"issue":"1","key":"R3-20250821","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1288\/00005537-198301000-00007","article-title":"The infratemporal fossa approach for nasopharyngeal tumors","volume":"93","author":"Fisch","year":"1983","journal-title":"Laryngoscope."},{"issue":"4","key":"R4-20250821","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1177\/019459989310900424","article-title":"Orbitocranial exposure in the management of infratemporal fossa tumors","volume":"109","author":"Leonetti","year":"1993","journal-title":"Otolaryngol Head Neck Surg."},{"issue":"5","key":"R5-20250821","doi-asserted-by":"crossref","first-page":"668","DOI":"10.3171\/jns.1990.73.5.0668","article-title":"Zygomatic approach to skull-base lesions","volume":"73","author":"Al-Mefty","year":"1990","journal-title":"J Neurosurg."},{"issue":"12","key":"R6-20250821","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1288\/00005537-196912000-00005","article-title":"The combined otolaryngology-neurosurgery approach to extensive benign tumors","volume":"79","author":"Kempe","year":"1969","journal-title":"Laryngoscope."}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1227\/ONS.0000000000000008","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:48:43Z","timestamp":1786121323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1227\/ONS.0000000000000008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,29]]},"references-count":6,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1227\/ons.0000000000000008","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,29]]},"assertion":[{"value":"2021-04-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}