Endoscopic Surgery for Juvenile Angiofibroma: When and How

Abstract

The endoscopic approach is a safe and effective technique that allows removal of small and intermediate-sized juvenile angiofibromas (without extensive involvement of the infratemporal fossa and cavernous sinus) with a low morbidity. Advanced lesions are more appropriately treated by external approaches.

Juvenile Nasopharyngeal Angiofibroma: A Rise in Incidence

“…Endoscopic surgery is becoming a promising approach for early stage growth mainly I and II. The main advantage of endoscopic surgery is the possibility of obtaining a broad view of the lesion and its anatomic relationship with adjacent structures, promoting more accurate, complete dissection and better control of bleeding [9][10][11]. Other advantages include less surgical time, hospitalization, absence of visible scars, avoids complication such as epiphora, dysesthesia, trismus, and craniofacial deformities [10,[12][13][14][15].…”

Ressecção endoscópica de nasoangiofibroma

“…Thus, prior embolization contributes to reduce surgical morbidity. Studies state that the ideal time between tumor embolization and the endoscopic surgical procedure should be around 24 to 72 hours 5 ; however, in our department this time has varied within an average of 4.7 days, with effective embolization of all the tumors and performance of all the endoscopic procedures without problems. The clinical observation in our clinic, considering the tumoral embolization of over 30 angiofibromas operated, not only through endoscopy, but also through open surgery, it has been between 5 and 7 days, after embolization as the ideal period for surgery, having seen that the tumor becomes more fibrous, with areas of necrosis and with much less bleeding than those operated with less than 3 days of wait, thus making the surgeon's life a lot easier.…”

“…Studies have shown that the endoscopic procedure is effective only for the total removal of small and intermediary size tumors [5][6][7][8] ; notwithstanding, there are studies that favor even the removal of tumors that extend to the pterigoid fossa and limited to the cranial fossa 9 . However, the debate remains, because studies have shown recur- (from 2 to 7 days) (Figures 1 and 2).…”

Comparison of Surgical Freedom and Area of Exposure in Three Endoscopic Transmaxillary Approaches to the Anterolateral Cranial Base

“…5,7,10,13,14,[16][17][18] In brief, the middle turbinate bone is removed through the ipsilateral nostril, and the inferior turbinate bone is reflected inferiorly or removed, allowing the ethmoid bulla to be identified. An antrostomy is performed using a Kerrison rongeur to allow access to the maxillary sinus (►Fig.…”

“…maxillary sinus have gradually replaced traditional open approaches for certain anterior and anterolateral skull base lesions. [4][5][6][7][8][9][10] The armamentarium of endoscopic approaches to this region includes the ipsilateral endonasal transmaxillary approach, sublabial transmaxillary approach (Caldwell-Luc), and the contralateral transseptal transmaxillary approach. 8 The anterolateral skull base is anatomically complex and has been well described.…”