Recent advances in the treatment of juvenile angiofibroma

Enepekides, Danny

doi:10.1097/01.moo.0000143970.19992.64

Cited by 60 publications

(65 citation statements)

References 18 publications

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“…Embolization of the maxillary artery is a relatively safe invasive procedure; a complication of this procedure is embolism into the intracranial circulation, but this event is rare. [15][16][17][18][19][20][21][22]30 In the present study, 62.5% of patients underwent embolization without complications; only 2 patients (12.5%) were not embolized, and required intraoperative blood transfusions. These results are similar to other published results.…”

Section: Discussionmentioning

confidence: 84%

“…In any of these techniques, the recommended treatment of choice is preoperative tumor embolization to decrease intraoperative bleeding when removing the angiofibroma. [15][16][17][18][19][20][21][22] This study reports the experience of an Otorhinolaryngology and Head & Neck Surgery Department in a school hospital from 2001 to 2008 with the diagnosis and treatment results of patients with juvenile nasopharyngeal angiofibroma.…”

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confidence: 99%

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Experiência de sete anos em pacientes com angiofibroma nasofaríngeo juvenil

Gaillard¹,

Anastácio²,

Piatto³

et al. 2010

Braz. j. otorhinolaryngol. (Impr.)

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Juveni le nasopharyngeal angiofibroma (JNA) is a rare tumor in adolescent males. It originates in the nasopharynx. Aim: to present the experience of JNA management at an Otorhinolaryngology Service between 2001 and 2008. Materials and Methods: Demographical data, clinical presentation, investigations as well as the treatment of sixteen JNA patients were reviewed and collected from medical records from the ORL Service. Design: Cross-sectional, retrospective and descriptive study. Results: All JNA patients were male. The average age at diagnosis was 16.8 years (range 9-23 years). More than 56% of the patients were classified as Fisch II. Preoperative embolization was carried out in ten (62.5%) patients. All 16 patients were submitted to primary surgical resection. Two patients (66.7%) who didn't receive preoperative embolization required intraoperative blood transfusion. The overall recurrence rate was 43.75% and the cure rate was 93.75%. Conclusion: Preoperative embolization minimizes intraoperative blood loss. The recurrence rate was related to advanced tumoral stage at diagnostic and the lack of preoperative embolization. Surgery combined with preoperative embolization is the major treatment for JNA. All the patients should undergo preoperative imaging studies, especially CT, to assist in surgical planning and follow-up.

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Section: Discussionmentioning

confidence: 84%

mentioning

confidence: 99%

Experiência de sete anos em pacientes com angiofibroma nasofaríngeo juvenil

Gaillard¹,

Anastácio²,

Piatto³

et al. 2010

Braz. j. otorhinolaryngol. (Impr.)

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“…This also makes the surgery difficult if required later on [14]. Adjunctive hormonal therapy has been tried which block the testosterone receptors [15]. The tumor course may have to be watched with repeat imaging study in case there are signs of regression.…”

Section: Discussionmentioning

confidence: 99%

Clinico-radiological evaluation of Juvenile Nasopharyngeal Angiofibromas: two case reports

Sharma¹,

Sharma²,

Sharma³

et al. 2017

EJMCR

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“…JNA that involves multiple compartments can be challenging to access surgically and has previously been approached by external open transfacial procedures that can carry substantial morbidity. 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.…”

Section: Case 1: Ipsilateral Endoscopic Endonasal Approach (Uninostrimentioning

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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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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Recent advances in the treatment of juvenile angiofibroma

Cited by 60 publications

References 18 publications

Experiência de sete anos em pacientes com angiofibroma nasofaríngeo juvenil

Experiência de sete anos em pacientes com angiofibroma nasofaríngeo juvenil

Clinico-radiological evaluation of Juvenile Nasopharyngeal Angiofibromas: two case reports

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

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