Nasopharyngeal angiofibroma: A concise classification system and appropriate treatment options

Yi, Zixiang; Fang, Zhipeng; Lin, Ge; Lin, Chi-Chung; Wenhui, Xiao; Li, Zhichun; Jin-mei, Cheng; Aidong, Zhou

doi:10.1016/j.amjoto.2012.10.004

Cited by 30 publications

(17 citation statements)

References 8 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%

“…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.…”

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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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“…3,4 Tissue biopsy is not recommended in the initial investigation of juvenile nasopharyngeal angiofibroma because of the risk of major haemorrhage. These account for 0.05 per cent of head and neck tumours, and typically present in teenagers but can occur in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Recurrent epistaxis in a nine-year-old boy: benign or malignant?

et al. 2015

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“…55 Although benign, JAFs can be locally invasive into the nasopharynx, and even intracranial extension is possible. They often arise in the sphenopalatine fossa.…”

Section: Angiofibromasmentioning

confidence: 99%

“…6,23,55,57,58 • In some instances, direct percutaneous puncture can be an option, when the ICA is the main vascular supply. 59,60 • Careful angiographic images should be obtained and thoroughly inspected prior to embolization to assess dangerous anastomosis; occasionally, the use of temporary balloon occlusion of the proximal blood supply from the ICA or VA may be an adjunctive safety measure.…”

Section: Angiofibromasmentioning

confidence: 99%