The infratemporal fossa approach for nasopharyngeal tumors.

Abstract

The technique and results of the infratemporal fossa surgical removal of carcinomas and juvenile angiofibromas of the nasopharynx are presented. Effective palliative removal of T4 and radical removal of T1 and T2 nasopharyngeal carcinomas was achieved. A classification of juvenile nasopharyngeal angiofibroma is presented. The infratemporal fossa approach allows radical removal of type III tumors and subtotal removal of type IV tumors. If residual tumor has to be left back in the cavernous sinus, irradiation is used to stop further growth of the tumor. If radiotherapy fails the neurosurgical removal of the intracranial portion of the tumor is indicated.

Preliminary Experience with the Percutaneous Embolization of Juvenile Angiofibromas Using Only Ethylene-Vinyl Alcohol Copolymer (Onyx) for Preoperative Devascularization Prior to Surgical Resection

“…There were 9 males, with a mean age of 15 years (range, 11-22 years): Two Fisch type I, 1 Fisch type II, 5 Fisch type IIIa, and 1 Fisch Type IVa tumor were treated. 9 According to the classification of Radkowski et al, 10 1 type IA, 1 type IB, 1 type IIA, 5 type IIIA, and 1 type IIIB tumor were treated. Complete devascularization of all 9 juvenile angiofibromas was achieved by using the direct percutaneous embolization technique with EVOH as the sole agent.…”

“…The size of the tumor was determined on angiography by the hypervascular blush. The maximum anteroposterior, transverse, and cranial caudal dimensions of each tumor are shown in the Table. The staging systems of Fisch 9 and Radkowski et al 10 were assessed by preoperative cross-sectional MR imaging. The approach and number of needles placed into the tumor, embolization time, operative time, surgical approach, blood transfusion requirement, and estimated blood loss from surgical excision were recorded from retrospective review of medical records.…”

Benign Tumours of Nasopharynx—Revisited

“…Surgical accesses to nasopharynx are many including the external and endoscopic approaches. External approaches are inferiorly-via a trans-palatal route; laterally via a transtemporal or infratemporal route; anteriorly via a maxillary swing approach [3,15]. These approaches have limited access and considerable post op morbidity due to extensive and complex mobilization [12,14,15].…”

Nasopharyngeal angiofibroma with cavernous sinus involvement — An unusual presentation

“…In addition, surgical defects in the dura surrounding the cavernous sinus can be difficult to repair, leading to the possibility of an uncontrollable cerebrospinal fluid leak (Mickey et al, 1988). Based largely on these concerns, most surgeons addressing the treatment of intracranial angiofibromas have advocated either nonsurgical treatment or incomplete resection of tumor involving this structure (Fisch 1983); Goepfert et al, 1985).…”