Endoscopic surgery of nasopharyngeal angiofibroma

Coblation assisted endoscopic juvenile nasopharyngeal angiofibroma resection

“…Endoscopic resection can be assisted by image-guidance, laser, coblation or ultrasonic scalpel [1]. Though large tumor size and intracranial/infratemporal fossa extension have been cited as contraindications to endoscopic resection, significant advantages in visualization, estimated blood loss (EBL), and morbidity, makes the endoscopic approach, extremely favorable [1][2][3][4][5]. Furthermore, the final EBL has been proven to be significantly reduced with concomitant pre-operative embolization [2][3][4].…”

Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension

“…Small type I and type II tumors have been removed via a transpalatal [9], midfacial degloving [10] or endoscopic approaches [11]. Type IIIa tumors, with infratemporal fossa or orbital involvement but without intracranial involvement, have been classically resected via a combined transpalatal and transmaxillary approaches [12], endoscopic assisted midfacial degloving approach [13] or the infratemporal fossa approach advocated by Fisch [5].…”

“…Despite the importance of operative time, few if any authors have discussed it. A single study discussing 9 JNAs with only one advanced type III JNA reported an operative time of 165 min for such procedure [11].…”

“…Opponents of the technique stress on the rare complications such as cerebral infarcts and vision loss which are generally secondary to abnormal collaterals from the internal maxillary artery to the intracranial and intraorbital contents [18]. On the contrary, most of the surgeons agree that preoperative embolization is a safe and effective procedure which should be performed but with an experienced radiologist [11,12,16,19]. Detailed assessment of the possible dangerous collaterals by superselective microcatheterization of the dangerous collaterals should be performed to avoid major complications [20].…”

“…Although, endoscopic surgery is becoming popular, it still has inherent limitations in far lateral access. The number of total cases of advanced JNA with infratemporal fossa extension operated exclusively endoscopically in literature is very small [11,19,30]. Lateral infratemporal extension of angiofibroma is considered an obstacle for exclusively endoscopic removal of JNA and the patient must be informed that it may be necessary to resort to an open surgery in such types of JNA [30].…”