Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature

Abstract

Close in 1994, and Gross in 1995 described the endoscopic modified Lothrop. All patients selected for this procedure had failed medical treatment of nasal saline and antiseptic irrigations, topical steroids, and appropriate antibiotics. Nearly all of these patients had also failed standard endoscopic sinus procedures at least once.Results: Image guidance has improved the precision and safety of this operation. Three of the first 5 procedures performed without image guidance failed. Of the succeeding 99 procedures performed with image guidance, 96% were successful in maintaining open frontal drainage and resolving most symptoms with a prolonged follow-up (mean 42 months).Conclusions: The endoscopic modified Lothrop is a technically difficult procedure. When performed under the supervision of an experienced endoscopic surgeon with image guidance and modern endoscopic irrigated curved drills, it can be performed safely and effectively when standard endoscopic procedures fail. Endoscopic Resection of Anterolateral Maxillary Sinus Inverted PapillomasNichole Dean, DO (presenter); Elisa A. Illing, MD; Bradford A. Woodworth, MD Objectives: Endoscopic medial maxillectomy (EMM) has become the surgical procedure of choice for resection of maxillary sinus inverted papillomas (IPs). Traditionally, IPs pedicled on the anterior and/or lateral walls of the maxillary sinus have required an adjuvant Caldwell-Luc approach due to decreased visualization with transnasal endoscopy in these locations. The objective of the current study is to evaluate outcomes concerning the endoscopic surgical resection of anterolateral maxillary sinus IPs.Methods: A prospective review of patients presenting with maxillary sinus IPs pedicled on the anterior and/or lateral walls was performed. Demographics, pedicle location, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated.Results: Over 6 years, 35 patients (avg. age 56) underwent EMM for maxillary sinus IPs located on the anterolateral maxilla. Most patients (69%) were referred for recurrence after previous attempts at surgical resection. Adequate visualization was obtained following EMM in the majority of patients with use of a 70° endoscope and angled instrumentation. The addition of transseptal surgical access was critical to the removal of IPs in 16 patients. No Caldwell-Luc approaches were required. Pathologic dysplasia was identified in 8 subjects, and 3 had carcinoma. There were no recurrences with a mean disease-free interval of 27 months (6-72 months).Conclusions: In the present study EMM provided excellent surgical access to anterolateral maxillary sinus IPs. The transseptal approach allowed enhanced visualization to this challenging location previously considered accessible only with external procedures.

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

“…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.…”

“…16,26,28 With the advent of minimally invasive endoscopic techniques, however, there have been several studies assessing the effectiveness of endoscopic resection of JNA. 4,7,12,18,20,22,24,30,35,36 In particular, the infratemporal fossa (ITF) is one of the most difficult areas to access during skull base surgery. More extensive JNAs that extend intracranially or extend into the lateral regions of the ITF become more challenging to resect via a purely endoscopic endonasal approach.…”

Do open and endoscopic resection approaches to juvenile nasopharyngeal angiofibroma result in similar blood loss and recurrence rates?

“…This approach identified 92 individual studies and a total of 821 patients. 2 The average blood loss was 564.2 mL; cases with preoperative embolization had an average blood loss of 414.6 mL, and those without preoperative embolization had an average blood loss of 774.2 mL. Although both of the systematic reviews include many of the same studies, the data support the concept that intraoperative blood loss is lower with the endonasal approach.…”

“…This study did not examine the complication rates among the three surgical approaches to JNA resection. A second systematic review by Khoueir et al (2014) focused solely on endoscopic resection of JNAs. This approach identified 92 individual studies and a total of 821 patients.…”

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

“…[1] Juvenil nazofarengeal anjiofibrom tüm baş ve boyun tümörlerinin %0.05 ile %1'ini oluşturan, histopatolojik olarak benign ancak klinik olarak agresif seyreden bir tümör-dür. [2] Tümör nazal kavitenin posterolateralinde, sfenopalatin foramenin üst sınırından köken almaktadır. Kitle buradan medialde nazal kavite ve paranazal sinüslere, lateralde pterigopalatin fossa (PPF) ve infratemporal fossaya (İTF), posteriorda ise internal karotis arter, kavernöz sinüs ve orbital apekse doğru büyüyebilir.…”