A New Endoscopic Staging System for Angiofibromas

Snyderman, Carl H.; Pant, Harshita; Carrau, Ricardo L.; Gardner, Paul A.

doi:10.1001/archoto.2010.83

Cited by 121 publications

(138 citation statements)

References 10 publications

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“…10,12,26,38 With the introduction of endoscopic skull base techniques, the surgical landscape has changed to now include endoscopic approaches as well as endoscope-assisted approaches to provide access to these tumors. 4,7,9,12,18,20,30,36 With this shift in surgical paradigms, the staging criteria used for JNA were revised by Snyderman et al 33 to place a higher emphasis on cranial base extension and remaining vascularity postembolization, characteristics they believed to be more predictive of morbidity and tumor recur- Currently, the most common approach to the ITF is the transcervical approach in a relaxed skin tension line, as it provides adequate access without poor cosmetic outcome and risk to the facial nerve. 8 This approach is not without limitations, as it is particularly challenging in tumors with great medial and superior extension.…”

Section: Case 1: Ipsilateral Endoscopic Endonasal Approach (Uninostrimentioning

confidence: 99%

“…19 Anterior bowing of the posterior maxillary wall, the Holman-Miller sign, is pathognomonic for JNA. 37 A variety of staging criteria systems are used, 2,6,11,23,27,32,33 each based on tumor spread. In addition, angiography is often performed to identify the primary vessels that feed the tumor, and allows for preoperative embolization to reduce intraoperative blood loss.…”

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confidence: 99%

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Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach

Liu

Husain²,

Kanumuri³

et al. 2016

JNS

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OBJECT Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring. METHODS This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1–3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1–4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus. RESULTS A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications. CONCLUSIONS An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.

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Section: Case 1: Ipsilateral Endoscopic Endonasal Approach (Uninostrimentioning

confidence: 99%

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confidence: 99%

Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach

Liu

Husain²,

Kanumuri³

et al. 2016

JNS

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“…Clinical features vary depending upon the extent of disease, but extensions into the sphenoid and other sinuses, orbit, infratemporal fossa and middle cranial fossa are often silent 5,6 . Alternately, such extensions may manifest with cheek swelling, proptosis or visual loss 6 .…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The primary treatment modality is surgical excision 6 and it remains a viable option in cases of intracranial extension 7,8 . However, the surgical plan needs to consider that a more extensive resection in an attempt to prevent recurrence is inherently associated with a higher degree of morbidity.…”

Section: Treatmentmentioning

confidence: 99%

Case Report: Atypical Clinical and Radiological Presentation of Juvenile Nasopharyngeal Angiofibroma

Ezzat¹,

Roshdy²,

Eid³

2014

IOSRJDMS

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“…Ayrıca hastaların yaklaşık %20'sinde kafa tabanının invazyonuna bağlı olarak intrakraniyal uzanım ortaya çıkmaktadır. [4] Juvenil nazofarengeal anjiofibrom için pek çok evreleme sistemi tanımlanmış olmakla beraber bu evreleme sistemleri genellikle tümörün yayılımına ve taraf bulgusuna göre yapılmak-tadır. Ancak bu sınıflama sistemleri genellikle endoskopik tekniklerin kullanılmadığı dönem-lerde geliştirildiğinden tümörün vasküler yapısı ve intrakraniyal uzanımı gibi önemli parametreleri içermemektedir.…”

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A juvenile nasopharyngeal angiofibroma: our 10-year experience in a tertiary centre

Şahin

Çomoğlu²,

Sönmez³

et al. 2016

Kulak Burun Bogaz Ihtis Derg

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ÖZAmaç: Bu çalışmada jüvenil nazofarengeal anjiofibrom nedeniyle ameliyat edilen hastaların demografik özellikleri, tümör evresi, cerrahi yöntem ve nüks oranları değerlendirildi. Hastalar ve Yöntemler: Bu retrospektif çalışmaya Mart 2006-Temmuz 2015 tarihleri arasında İstanbul Üniversitesi, İstanbul TıpFakültesi Kulak Burun Boğaz Hastalıkları kliniğinde ameliyat edilen 45 hasta (44 erkek, 1 kadın; ort. yaş 21 yıl; dağılım 9-55 yıl) dahil edildi. Hastalar yaş, cinsiyet, başvuru semptomu, tümörün evresi, uygulanan cerrahi yöntem, ameliyat öncesi embolizasyon, ameliyat sırası kan transfüzyonu, komplikasyonlar ve nüks varlığına göre sınıflandırıldı. Bulgular:En sık başvuru semptomu burun kanaması (%78) ve burun tıkanıklığı (%73) idi. Hastaların tamamına ameliyat öncesi anjiyografi yapıldı ve uygun olan hastalara (%69) embolizasyon uygulandı. Otuz bir hastada transnazal endoskopik yaklaşım, altı hastada midfasiyal degloving ve üç hastada lateral rinotomi yaklaşımı uygulandı. Genel nüks oranı %31 (n=14) idi. Sonuç:Ameliyat sonrası nüks riskini belirleyen en önemli faktör, tümörün ameliyat öncesi evresidir. Ameliyat öncesi embolizasyon, ameliyat sırası kanama miktarını azaltmaktadır. Endoskopik transnazal yaklaşım komplikasyon oranını ve hastanede yatış süresini kısaltmaktadır.Anahtar Sözcükler: Embolizasyon; endoskopik yaklaşım; jüvenil nazofarengeal anjiofibrom; minimal invaziv cerrahi; sonuç. ABSTRACT Objectives:This study aims to evaluate the demographic characteristics, tumor stage, surgical treatment and recurrence rate among patients operated with a juvenile nasopharyngeal angiofibroma. Patients and Methods:This retrospective study included 45 patients (44 males, 1 female; mean age 21 years, range 9 to 55 years) who underwent surgery at Istanbul University, Istanbul Medical Faculty, Department of Otorhinolaryngology clinic between March 2006 and July 2015. The patients were classified according to age, sex, presenting symptom, tumor stage, surgical procedure applied, preoperative embolization, perioperative blood transfusion, complications, and the presence of recurrence. Results:The most common presenting symptoms were epistaxis (78%) and nasal obstruction (73%). Preoperative angiography was performed on all patients and embolization was applied in eligible patients (69%). Transnasal endoscopic approach in 31 patients, midfacial degloving in six patients, and lateral rhinotomy approach in three patients were applied. The overall recurrence rate was 31% (n=14). Conclusion:The most important factor in determining the risk of postoperative recurrence is the preoperative tumor stage. Preoperative embolization reduces the amount of perioperative bleeding. Endoscopic transnasal approach decreases the rate of complications and length of hospitalization.

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A New Endoscopic Staging System for Angiofibromas

Cited by 121 publications

References 10 publications

Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach

Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach

Case Report: Atypical Clinical and Radiological Presentation of Juvenile Nasopharyngeal Angiofibroma

A juvenile nasopharyngeal angiofibroma: our 10-year experience in a tertiary centre

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