Transnasal Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma without Preoperative Embolization

Borghei, Peyman; Baradaranfar, Mohammad Hossein; Borghei, Seyed Hebatodin; Sokhandon, Farnoosh

doi:10.1177/014556130608501114

Cited by 39 publications

(34 citation statements)

References 22 publications

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“…The endoscopic resection of tumors in the nasal cavity, paranasal sinuses and pterygopalatine fossa is well established compared with the external approaches [9,12,[19][20][21][22]. Intraoperative visualization of the tumor limits in the complex area of the pterygopalatine fossa, with endoscopes of various angles, is superior to that of the unaided eye.…”

Section: Discussionmentioning

confidence: 99%

“…Intratumoral embolization, whenever applicable, avoids occlusion of intracranial or intraorbital vessels and should be the first choice for reducing the tumor vascularity [10,34]. JNAs may be operated endoscopically despite the lack of preoperative embolization without significant hemorrhage or increased rate of recurrence [19,20].…”

Section: Adjunctive Proceduresmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Adjunctive Proceduresmentioning

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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“…Transpalatal, transmaxillar (lateral rhinotomy or midfacial degloving), Le Fort 1 osteotomy and infratemporal fossa approaches [2,9,12,13] used to be the traditional surgical methods commonly used to remove JNA. Recent reports recommend endoscopic surgery [4,11,[16][17][18][19]. However, the most suitable choice for each patient remains under discussion.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of endoscopic approach are enhanced surgical visualisation with magniWed and multiangled views, which is thought to prevent overlooking of tumour remnants, along with the avoidance of facial scars and bone disruption [11]. Endoscopic surgery is also associated with lower morbidity, low rate of complications, and shorter duration of hospitalisation [16,17]. Many authors have described the importance of exploring the basis of the sphenoid to remove all tumours invading the cancellous bone at the skull base [14,15,28], which might be better achieved with endoscopic resection [14,15,28].…”

Section: Discussionmentioning

confidence: 99%

“…However, recurrence rates as high as 50% (ranging from 6 to 50%) have been reported [14,15]. There are numerous reports about endoscopic resections, started in 1993 in Barcelona and in 1994 in Graz [4,11,[16][17][18][19]. Due to its minimal invasiveness, low morbidity rate, and typically low rates of recurrence this approach is gaining popularity.…”

Section: Introductionmentioning

confidence: 99%

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The changing surgical management of juvenile nasopharyngeal angiofibroma

Renkonen

Hagström

Vuola

et al. 2010

Eur Arch Otorhinolaryngol

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The management of juvenile nasopharyngeal angiofibroma (JNA) has changed during the last decades but it still continues to be a challenge for the multidisciplinary head and neck surgical team. The aim of this study was to review the used treatment approach and outcome of JNA in a single institution series of 27 patients diagnosed and treated during the years 1970-2009. All patients were male, with the median age of 17 years (range 11-33 years). Surgery was used as the primary treatment in every case. Surgical approaches varied, transpalatal approach (N = 14) being the most common approach used in this series. During the last decade various other techniques were applied, including endoscopic (N = 3) resection. Two patients were additionally treated with antiangiogenic agents and one patient with stereotactic radiotherapy. The primary recurrence rate was 37% and it seemed to correlate with vascular density of tumour and the surgical approach used. We suggest that the management of JNA should be planned by an experienced head and neck surgeon, as part of a multidisciplinary team, preferably in a tertiary referral setting, and the recent development of the available therapies should be taken into account to minimise the risk of recurrence.

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

160

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Transnasal Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma without Preoperative Embolization

Cited by 39 publications

References 22 publications

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

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

The changing surgical management of juvenile nasopharyngeal angiofibroma

ICAR: endoscopic skull‐base surgery

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