Preoperative emobilisation of juvenile nasopharyngeal angiofibroma

Meher, Ravi; Kathuria, Sanjeev; Wadhwa, Vibhor; Ali, Mohamed Riyas; Shah, Bhushan; Bansal, Ankit; Goel, Prakhar

doi:10.1016/j.amjoto.2022.103532

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…The mean tumor diameter was 4.5 cm for JNA cases UPMC Stages II to III and 7 cm for JNA case UPMC Stage V. To reduce the intraoperative time, blood loss, and tumor relapse rate, all tumors were successfully embolized before resection. 24 A pure extended EEA was used in 6 cases (UPMC Stages II-III; Radkowski IIA) (Figure 1); a multiportal EEA + Caldwell-Luc was used in 2 cases with ITF invasion (UPMC Stages II-III; Radkowski IIB-IIIB) (Figure 2). One patient treated by a multiportal EEA + Caldwell-Luc (UPMC Stage V; case 8) because of the presence of residual tumor in the left middle fossa floor and temporal pole (Dmax 4.8 × 2.6 × 2.3) was treated using a staged left temporal and transzygomatic craniotomy, obtaining gross total resection without major neurological complications.…”

Section: Resultsmentioning

confidence: 99%

Anatomic Considerations Guiding Single Versus Multiportal Endoscopic Approaches for Resection of Juvenile Nasopharyngeal Angiofibroma: Cases Series With Graded Multicorridor Resections

Bove

Pangal

Ruzevick

et al. 2023

Operative Neurosurgery

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BACKGROUND: Juvenile nasopharyngeal angiofibromas (JNAs) are characterized by expansive and destructive growth, often invading the midline/paranasal sinuses, pterygopalatine fossa, and infratemporal fossa and can extend into the orbit, cavernous sinus, or intracranially. OBJECTIVE: To evaluete the major benefits of the extended endoscopic endonasal approach (EEA) for JNA resection as compared with more traditional and invasive transpalatal and transfacial approaches. When JNAs extend into lateral anatomic compartments, the optimal operative trajectory often requires additional approach strategies or surgical staging. METHODS: We retrospectively reviewed 8 cases of large JNAs arising in symptomatic adolescent boys (University of Pittsburgh Medical Center Stages II, III, and V) and discuss anatomic and tumor considerations guiding the decision of a pure EEA vs combined EEA and sublabial transmaxillary approach (Caldwell-Luc). RESULTS: A pure extended EEA was used in 6 JNA cases (UPMC Stages II-III); a multiportal EEA + Caldwell-Luc maxillotomy was used in 2 cases. One of the 2 patients (UPMC Stage V) previously treated with multiportal EEA + Caldwell-Luc maxillotomy underwent staged left temporal/transzygomatic craniotomy, obtaining gross total resection. Seven patients ultimately underwent complete removal without recurrence. One patient with a small residual JNA (UPMC II) underwent stereotactic radiosurgery without progression to date. CONCLUSION: JNAs with lateral extension into the infratemporal fossa often benefited from additional lateral exposure using a Caldwell-Luc maxillotomy. Cases with significant skull base and/or dural involvement may undergo staged surgical treatment; temporalis + transzygomatic craniotomy is often useful for second-stage approaches for residual tumor in these lateral infratemporal or intracranial regions. SRS should be considered for residual tumor if additional surgery is not warranted.

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Section: Resultsmentioning

confidence: 99%

Anatomic Considerations Guiding Single Versus Multiportal Endoscopic Approaches for Resection of Juvenile Nasopharyngeal Angiofibroma: Cases Series With Graded Multicorridor Resections

Bove

Pangal

Ruzevick

et al. 2023

Operative Neurosurgery

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“…Preoperative measures to reduce blood loss, such as tumor embolization, may be clinically beneficial. In recent studies, preoperative embolization with polyvinyl alcohol has been reported to have a significant role in reducing blood loss during tumor resection, particularly in highly vascular tumors like nasopharyngeal angiofibroma [2]. Therefore, preoperative embolization of the feeder vessels with gel foam slurry was performed in our case 24 hours before the planned surgery.…”

Section: Discussionmentioning

confidence: 96%

“…The management of JNA is tricky, as biopsy is contraindicated because of the risk of intractable bleeding at the puncture site. The role of pre-operative embolization of the internal maxillary artery is important to aid in hemostasis during surgical resection [2]. The treatment of choice for JNA is surgical resection through open or endoscopic approaches.…”

Section: Introductionmentioning

confidence: 99%

Juvenile nasopharyngeal angiofibroma: A case report and literature review

Adhikari

2023

J Clin Images Med Case Rep

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“…Artery embolization can be performed to minimize bleeding during surgery and facilitate tumor resection. 1,6,13,16,20,21 Recent technological advances have made this procedure safer and more effective, justifying the continuation of this practice. 1,18,28 Nevertheless, data regarding transoperative blood loss after preoperative embolization in JNA resection surgery is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…7,9 Preoperative embolization is used in most surgical procedures due to the vascular nature of the tumor, and it is considered an acceptable means of decreasing intraoperative blood loss. 1,6,12,13,15,16,20,21 The present study intends to describe the experience with a series of 96 JNA cases treated in one institution: Instituto Felippu de Otorrinolaringologia (IFO), in São Paulo, Brazil.…”

Section: Introductionmentioning

confidence: 99%

Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases

Felippu,

Fontes,

Felippu

et al. 2024

Int Arch Otorhinolaryngol

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Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascularized tumor that affects almost exclusively male adolescents. Surgery is the treatment of choice for JNA. Objectives The present study is a 42-year retrospective review of a series of JNA cases treated surgically without previous embolization. Methods The present is a retrospective, descriptive study based on medical records of 96 patients with JNA who underwent microscopic or endoscopic excision without previous embolization from 1978 to 2020 in a single institution. The patients were categorized according to the Andrews et al. stage, and data were collected on age, gender, tumor staging, surgical approach, affected side, and outcome. Results All patients were male, with an average age of 17 years. The predominant tumor stage consisted of type II, with 52.1%. A total of 33.3% of the patients were submitted to the microscopic technique and 66.7%, to the endonasal technique. The rate of intraoperative blood transfusion was of 17.7%. Conclusion The present study reinforces that resection of JNA in various stages is viable without previous artery embolization.

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Preoperative emobilisation of juvenile nasopharyngeal angiofibroma

Cited by 5 publications

References 11 publications

Anatomic Considerations Guiding Single Versus Multiportal Endoscopic Approaches for Resection of Juvenile Nasopharyngeal Angiofibroma: Cases Series With Graded Multicorridor Resections

Anatomic Considerations Guiding Single Versus Multiportal Endoscopic Approaches for Resection of Juvenile Nasopharyngeal Angiofibroma: Cases Series With Graded Multicorridor Resections

Juvenile nasopharyngeal angiofibroma: A case report and literature review

Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases

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