The management of extensive juvenile nasopharyngeal angiofibroma involving the carotid artery: An illustrative case series and literature review original

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumor arising most often in adolescent males. Although histologically benign, its aggressive growth pattern and tendency to infiltrate surrounding structures, especially near the skull base and internal carotid artery (ICA), make treatment particularly challenging. This series presents 3 illustrative cases of extensive JNA with ICA involvement, focusing on diagnostic imaging, surgical strategies, vascular management, and long-term outcomes. We report 3 cases of extensive JNA with ICA involvement in adolescent males. All patients underwent preoperative embolization followed by endoscopic resection; 2 experienced recurrences requiring adjuvant radiotherapy, while one remained recurrence-free after surgery alone. These cases highlight the surgical challenges posed by vascular involvement, particularly near the ICA, where careful planning, embolization, and use of endoscopic techniques are critical. Recurrence risk remains despite aggressive treatment, especially with complex extensions. Managing extensive JNA requires a multidisciplinary approach combining embolization, endoscopic surgery, and radiotherapy, when necessary, supported by long-term follow-up to monitor for recurrence.