Stage III nasopharyngeal angiofibroma: Improving results with endoscopic-assisted midfacial degloving and modification to the Fisch staging system

Shah, Saurin; Keshri, Amit; Patadia, Simple; Sahu, Rabi Narayan; Srivastava, Arun Kumar; Behari, Sanjay

doi:10.1016/j.jcms.2015.07.025

Cited by 7 publications

(4 citation statements)

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“…Though we have various methods to reduce bleeding like direct puncture embolization (DPE), coblation, or laser (Shah et al). 6 These all aim at working extravascular and all these have their own limitation. Transarterial angiography with embolization aims at working at the intravascular level.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the CECT, CEMRI, and transarterial angiography with embolization findings, the tumor was staged based on the modified Fisch staging system (Shah et al). 6 Patients were operated within 24 to 72 hours of transarterial angiography with embolization. The surgical approach was decided based on the staging system, stages I and II were resected endoscopically because the tumor was completely accessible, and the bleeding, if at all occurs can be managed endoscopically, whereas stages IIIAa e , IIIAa i , IIIBa e , IIIBa i , and stage IV required an open approach not only to expose the entire tumor but also to handle the bleeders from branches of ICA that were not embolized during transarterial angiography.…”

Section: Methodsmentioning

confidence: 99%

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Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

Manogaran

Mathialagan

Singh

et al. 2020

J Neurol Surg B Skull Base

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Objectives This study was aimed to understand the usefulness of transarterial angiography and embolization in management of juvenile nasopharyngeal angiofibroma (JNA) and to apply the information obtained to stage the disease, select appropriate surgical approach, predict intraoperative bleeding, and prognosticate the disease. Design This study represents a retrospective review of the patients of JNA with major focus on transarterial angiography and embolization findings and its clinical and surgical implications. Setting The study conducted at a tertiary-care super-specialty referral center. Participants Forty-two patients who had undergone transarterial angiography and embolization followed by surgery over the period of 5 years from July 2015 till February 2019 were participated in this study. Main Outcome Measures Tumor vascular pattern based on transarterial angiography, staging of the disease based on extent and vascular supply, surgical approach selected, and prognosticating the disease were determined from this study. Conclusion Transarterial angiography with embolization becomes a prudent preoperative investigation for management of JNA. It provides a complete three-dimensional map of the tumor with stage-specific vascular pattern, reduces vascularity of the tumor, and predicts the sites from where bleeding can occur intra operatively. Thus, it helps in choosing the appropriate surgical approach aiding in complete tumor removal with minimal bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

Manogaran

Mathialagan

Singh

et al. 2020

J Neurol Surg B Skull Base

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“…GTR was reported in all studies and achieved in 376 patients (90.6%). The included studies had wide heterogeneity in data reporting and did not include subgroup analysis based on embolized versus nonembolized 20 16 (12)(13)(14)(15)(16)(17)(18)(19)(20) 12 males Radkowski: IB (1), IIA (2), IIB (4), IIC (1), IIIA (4) El-Banhawy et al 21 15.5 (8-20) 15 males Andrews-Fisch: IIIa (4), IIIb (11) Hofmann et al 22 17 (13-24) 21 males Andrews-Fisch: I (1), II (14), IIN (1), IIIa (5) Yiotakis et al 23 14.9 (12-18) 20 males Radkowski: Ia (3), Ib (3), IIa (3), IIb (8), IIc (3) Nicolai et al 24 17 46 males Andrews-Fisch: I (5), II (24), IIIa (14), IIIb (3) López et al 25 16 (11)(12)(13)(14)(15)(16)(17)(18) 47 males; 1 female Andrews-Fisch: I (1), II (12), IIIa (13), IIIb (14), IVa (7), IVb (1) Lv et al 9 16 (9-24) 22 males Radkowski: IIc (12), IIIa (5), IIIb (5) Shah et al 26 16 (10-21) 15 males Andrews-Fisch: IIIa (10), IIIb (5) Mujtaba Khan et al 27 16.2 (9-24) 30 males Andrews-Fisch: I (4), II (15), IIa (2), IIIa (7), IIIb (2) Overdevest et al 6 16.7 (7-33) 26 males Radkowski: Ib (3), IIa (5), IIb (4), IIc (5), IIIa (7), IIIb (2) Llorente and López 28 17 (8-39) 30 males; 1 female Radkowski: I (1), IIA (5), IIB (9), IIC (4), IIIA…”

Section: Surgical Outcomes and Tumor Recurrencementioning

confidence: 99%

Preoperative Embolization Techniques in the Treatment of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review

Kothari

Linker

Tham

et al. 2023

Otolaryngol.--head neck surg.

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ObjectivePreoperative embolization has proven beneficial in the surgical treatment of juvenile nasopharyngeal angiofibromas (JNA). However, the consensus for the best embolization practices remains unclear. This systematic review seeks to characterize the reporting of embolization protocols throughout the literature and to compare differences in surgical outcomes.Data SourcesPubMed, Embase, and Scopus.Review MethodsStudies investigating embolization in the treatment of JNA from 2002 to 2021 were selected from defined inclusion criteria. All studies underwent a 2‐stage blinded screening, extraction, and appraisal process. Embolization material, time to surgery, and embolization route were compared. Embolization complications, surgical complications, and rate of recurrence were pooled.ResultsOf 854 studies, 14 retrospective studies with 415 patients met the criteria for inclusion. A total of 354 patients underwent preoperative embolization. A total of 330 patients (93.2%) underwent transarterial embolization (TAE) and 24 patients had a combination of direct puncture embolization and TAE. Polyvinyl alcohol particles were the most used embolization material (n = 264, 80.0%). The most common reported time to surgery was 24 to 48 hours (n = 8, 57.1%). Pooled results showed an embolization complication proportion of 3.16% (95% confidence interval [CI]: 0.96‐6.60) (n = 354), a surgical complication proportion of 4.96% (95% CI: 1.90‐9.37) (n = 415), and a recurrence proportion of 6.30% (95% CI: 3.01‐10.69) (n = 415).ConclusionThe current data on JNA embolization parameters and their effect on surgical outcomes remains too heterogenous to provide expert recommendations. Future studies should use uniform reporting to allow for more robust comparisons of embolization parameters, which, in turn, may lead to optimized patient outcomes.

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“…Благодаря развитию эндоскопической техники и накопленному хирургическому опыту, в настоящее время стало возможным удалять юношескую ангиофиброму основания черепа как на ранних стадиях [2,3], так и при распространенном опухолевом процессе [4][5][6].…”

Section: Introductionunclassified

Subcutaneous emphysema and pneumomediastinum after endoscopic transnasal removal of nasopharyngeal angiofibroma

Кузнецов

Voronov

Dvorianchikov

et al. 2021

Opuholi golovy i šei

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Introduction. Juvenile nasopharyngeal angiofibroma is a rare, benign, well-vascularized tumor of the skull base characterized by destructive growth. The development of endoscopic techniques and experience of surgeons have enabled the removal of this tumor both at early stages and late stages (advanced disease). Patients may develop various complications in the intraoperative and postoperative periods, including massive bleeding, nasal liquorrhea, facial paresthesia, lacrimal hyposecretion, etc. Air penetration into the subcutaneous fat and mediastinum during endoscopic surgery on the paranasal sinuses is rare. Such complication as subcutaneous emphysema and pneumomediastinum after endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma has not been reported in the literature.Case report. A 19-year-old male patient has undergone endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma. The tamponade was removed within the first 24 h postoperatively. Ten hours after it, the patient developed subcutaneous emphysema and pneumomediastinum triggered by sneezing. The diagnosis was confirmed by computed tomography of the neck and chest. The patient was transferred to the intensive care unit and received conservative treatment (including infusion, antibacterial, and antiinflammatory therapy). The symptoms of subcutaneous emphysema and pneumomediastinum subsided in response to treatment. Follow-up examinations (computed tomography and magnetic resonance imaging) confirmed that the tumor had been completely removed. The patient was discharged in a satisfactory condition.Conclusion. Subcutaneous emphysema and pneumomediastinum are exceedingly rare complications of endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma and are caused by anatomical connection between the parapharyngeal / retropharyngeal spaces and mediastinum. To prevent such complications, it is necessary to keep tampons in the nasal cavity for at least 2 days, as well as to instruct patients after surgery (avoid sneezing with their mouth closed, lifting weights, coughing, and vomiting). The nasoseptal flap used to repair the nasopharyngeal defect after tumor removal also ensures its sealing. Patients with complications should undergo computed tomography of the neck and chest (in case of emergency) and should be transferred to an intensive care unit. Conservative treatment (antibacterial and antiinflammatory therapy) will ensure good results in most patients.

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Stage III nasopharyngeal angiofibroma: Improving results with endoscopic-assisted midfacial degloving and modification to the Fisch staging system

Cited by 7 publications

References 10 publications

Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

Preoperative Embolization Techniques in the Treatment of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review

Subcutaneous emphysema and pneumomediastinum after endoscopic transnasal removal of nasopharyngeal angiofibroma

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