Transnasal endoscopic management of recurrent juvenile nasopharyngeal angiofibroma

Sharkawy, A. Adam; Elmorsy, Shawky

doi:10.1016/j.ijporl.2011.01.033

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…The strategies for treatment include surgery, chemotherapy, estrogen therapy, primary radiation, 5,13 cryosurgery, and surgical resection followed by gamma knife radiosurgery of residual tumor, 14 or transnasal endoscopic management of recurrent lesions. 15 The treatment of choice is radical surgical resection, but the vascular nature of JNAs has made embolization an important component of preoperative management, and preoperative embolization is a useful adjuvant in large and/or vascularized tumors 3,5 and is even considered mandatory by the latest articles of experienced teams. 14,16…”

Section: Discussionmentioning

confidence: 99%

Bilateral Non-Superselective Embolization With Particles Under Transient Occlusion of the Internal Carotid Artery in the Management of Juvenile Nasopharyngeal Angiofibroma

Santos-Franco

Lee

Campos-Navarro

et al. 2012

Vasc Endovascular Surg

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Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.

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Section: Discussionmentioning

confidence: 99%

Bilateral Non-Superselective Embolization With Particles Under Transient Occlusion of the Internal Carotid Artery in the Management of Juvenile Nasopharyngeal Angiofibroma

Santos-Franco

Lee

Campos-Navarro

et al. 2012

Vasc Endovascular Surg

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“…Monitoring is also justified for small residual disease in sensitive areas (e.g., around the cavernous sinus) [24]. Symptomatic or progressing recurrences call for additional treatment: intranasally accessible tumors may be treated endoscopically [23,39], and tumors with lateral or intracranial extension require an open anterior or lateral approach [24]. Gamma knife has been used successfully to control residual disease in the orbit or brain after surgery in select cases [40].…”

Section: Recurrence Of Jna After Endoscopic Resectionmentioning

confidence: 99%

Endoscopic treatment of juvenile nasopharyngeal angiofibromas: our experience and review of the literature

Fyrmpas

Konstantinidis

Constantinidis

2011

Eur Arch Otorhinolaryngol

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The endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) emerges as an alternative approach to open procedures due to reduced morbidity and comparable recurrence rates. The purpose of this study was to present our experience with the endoscopic management of JNA using retrospective chart review of ten male patients (mean age 15.7 years) with JNA who were treated endoscopically at our institution between the years 2003 and 2010. According to the Radkowski's system, one patient was at stage Ia, two at stage Ib, one at stage IIa, two at stage IIb, two at stage IIc (infratemporal fossa invasion) and two at stage IIIa (clivus erosion). Six patients underwent preoperative embolization. The endoscopic treatment involved total ethmoidectomy, middle meatal antrostomy, sphenoidotomy, clipping of the sphenopalatine artery and its branches and drilling of the pterygoid basis. All patients underwent magnetic resonance imaging 3 months postoperatively and then if indicated clinically. Mean follow-up was 23.7 months (range 3-70). All but one patient were free of macroscopic disease. A patient with stage IIb JNA developed a recurrence after 9 months. The residual tumor was resected endoscopically and the sphenopalatine foramen widened by drilling. The patient is free of disease 25 months postoperatively. The intra-operative blood loss was not excessive (200-800 ml, mean: 444 ml) and no patient required a blood transfusion. Patients were discharged after 4-8 days (mean 5 days). One patient developed postoperative infraorbital nerve hypoesthesia. Results showed that endoscopic treatment of stage I and IIa/b JNA is a valid alternative to external approaches. For select tumors with limited infratemporal fossa invasion and skull base erosion, the endoscopic approach may also be indicated. It is a safe and effective treatment modality due to the lack of external scars, minimal bone resection and blood loss and low recurrence rate.

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“…Of these, 72 (17%) patients with intracranial involvement from 15 studies were included in the final analysis (Fig. ) …”

Section: Methodsmentioning

confidence: 99%

A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement

Leong

2013

The Laryngoscope

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Objectives/Hypothesis Although transnasal endoscopic resection has become an established treatment for most juvenile nasopharyngeal angiofibroma (JNA), surgical management of JNA with intracranial extension remains challenging. This study systematically reviews the JNA literature to determine surgical outcomes. Study Design Systematic review. Methods A systematic search of the PubMed was undertaken using a combination of MeSH terms: angiofibroma, nasopharynx. The search was limited to articles published in the English language between January 1990 and April 2012. Each article was reviewed to identify sufficient individual data on patients treated for JNA, defined as reporting on demographics, JNA stage, the specific surgical approach, complications, and length of follow‐up for each patient. Results A total of 72 patients from 15 studies were included in this review. The mean age was 15.7 years. The mean follow‐up period was 47 months. Most patients had a craniofacial procedure. The overall mean estimated intraoperative blood loss was 1,709 mL. Preoperative embolization resulted in significantly less blood loss. The most common complications were sinonasal and neurological. Facial paresthesia was reported in 16%, followed by ophthalmoplegia (12%) and intranasal crusting (12%). Recurrence was reported in 13 patients (18%), which were detected between 7 and 26 months during the follow‐up period. Overall, 86% of the cohort was free of disease. Conclusions Surgical management of JNA with intracranial extension is complex and requires an expert multidisciplinary team. Although craniofacial approaches appear to be the current standard of treatment, there is increased experienced‐based evidence that endoscopic resection of large tumors or endoscopic‐assisted resection is feasible in expert hands. Level of Evidence 3a.

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Transnasal endoscopic management of recurrent juvenile nasopharyngeal angiofibroma

Cited by 8 publications

References 18 publications

Bilateral Non-Superselective Embolization With Particles Under Transient Occlusion of the Internal Carotid Artery in the Management of Juvenile Nasopharyngeal Angiofibroma

Bilateral Non-Superselective Embolization With Particles Under Transient Occlusion of the Internal Carotid Artery in the Management of Juvenile Nasopharyngeal Angiofibroma

Endoscopic treatment of juvenile nasopharyngeal angiofibromas: our experience and review of the literature

A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement

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