Long‐term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma

Abstract

Objectives/Hypothesis Although transnasal endoscopic resection (TER) of juvenile angiofibroma (JA) is unquestionably less invasive than traditional external approaches, several endonasal and neurovascular structures are sacrificed during the procedure. The aim of this study was to evaluate long‐term neurological morbidity and related quality of life following TER of JA. Study Design Retrospective cohort study. Methods All patients who underwent TER for JA at the Unit of Otorhinolaryngology–Head and Neck Surgery of the University of Brescia from 1994 to 2016 were contacted to know their availability to undergo a battery of tests aimed to assess lacrimal secretion (Schirmer test), impairment of sensitive nerves (electrophysiological threshold test), and impact on quality of life of tearing reduction and sensitivity impairment with the Ocular Surface Disease Index (OSDI) and visual analogue scale (VAS) (0–10), respectively. Results Thirteen patients were included. Mean follow‐up was 77 months (range, 19–156 months). The median Schirmer test value was 5.5 mm and 28.5 mm for the treated and untreated sides, respectively (P = .003). Analysis of sensitivity revealed significant impairment only in the hard palate. The mean OSDI score was 6.8 (normal). The mean values of the VAS scores for hard palate, buccal mucosa, gum, and premaxillary skin were 1.7, 1.7, 1.2, and 2.3, respectively. Conclusions TER for JA can result in objective reduction of lacrimal secretion and sensitivity impairment; nevertheless, their impact on quality of life is negligible. The predictable neurological morbidity of TER should be discussed during preoperative counseling. Level of Evidence 4 Laryngoscope, 129:2184–2188, 2019

Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

“…19 Advanced JNAs with skull base erosion or intracranial extension are uncommon. However, the prevalence of these extensive tumors in our series was 45% (10 patients), higher than recent frequencies reported by Glad et al (7%), 1 Mattavelli et al (12%), 27 Lutz et al (20%), 14 Abdelwahab et al (26%), 28 Pryor et al (29%), 15 Mujtaba Khan et al (30%), 29 Roche et al (43%) 17 but lower than Nicolai et al (54%), 30 Huang et al (54), 31 Snyderman et al (71%), 12 and Pamuk et al (77%). 32 One possible reason for this is that complex cases that have otherwise been deemed inoperable at other hospitals are often referred to the Mayo Clinic for a second opinion, thereby selecting for more advanced tumors.…”

“…One of the main comorbidities associated with the endoscopic approach is sensitivity impairment secondary to manipulation and sacrifice of different neurovascular structures. 27 In our study, 44% of the patients experienced postoperative partial numbness in V2/V3 territory, but this was temporary and all improved at follow-up. Combined (craniofacial and cranioendoscopic) approaches to maintain an important role for patients with extensive intracranial tumors or with encasement of critical neurovascular structures.…”

“…One of the main comorbidities associated with the endoscopic approach is sensitivity impairment secondary to manipulation and sacrifice of different neurovascular structures. 27 In our study, 44% of the patients experienced postoperative partial numbness in V2/V3 territory, but this was temporary and all improved at follow-up.…”

Total Endoscopic or Endoscope-Assisted Excision of Non-embolized Advanced Juvenile Nasopharyngeal Angiofibroma: A Clinical Case Series

“…The loss of sensations due to neurovascular manipulation is one of the major adverse effects of endoscopic approaches [ 15 ]. In the present case study, four out of six patients had postoperative temporary numbness in the ipsilateral V2 territory, which was reported to have been improved in the follow-up.…”