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

被引:24
作者
Liu, James K. [1 ,2 ,3 ]
Husain, Qasim [2 ]
Kanumuri, Vivek [2 ]
Khan, Mohemmed N. [2 ]
Mendelson, Zachary S. [1 ]
Eloy, Jean Anderson [1 ,2 ,3 ]
机构
[1] Rutgers State Univ, New Jersey Med Sch, Neurol Inst New Jersey, Dept Neurol Surg, Newark, NJ 07102 USA
[2] Rutgers State Univ, New Jersey Med Sch, Neurol Inst New Jersey, Dept Otolaryngol Head Neck Surg, Newark, NJ 07102 USA
[3] Rutgers State Univ, New Jersey Med Sch, Neurol Inst New Jersey, Ctr Skull Base & Pituitary Surg, Newark, NJ 07102 USA
关键词
juvenile nasopharyngeal angiofibroma; sinonasal tumor; anterior skull base tumor; endoscopic anterior skull base tumor resection; infratemporal fossa; vascular sinonasal tumor; oncology; INFRATEMPORAL FOSSA; MANAGEMENT; DIAGNOSIS; SURGERY; REMOVAL; SYSTEM;
D O I
10.3171/2014.12.JNS141696
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE 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.
引用
收藏
页码:1328 / 1338
页数:11
相关论文
共 39 条
[1]   Exclusively endoscopic surgery for juvenile nasopharyngeal angiofibroma [J].
Andrade, Nilvano A. ;
Pinto, Jose Antonio ;
Nobrega, Monica de Oliveira ;
Aguiar, Jose Estelita P. ;
Aguiar, Tamara Ferraro A. P. ;
Vinhaes, Eriko S. A. .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2007, 137 (03) :492-496
[2]   THE SURGICAL-MANAGEMENT OF EXTENSIVE NASOPHARYNGEAL ANGIOFIBROMAS WITH THE INFRATEMPORAL FOSSA APPROACH [J].
ANDREWS, JC ;
FISCH, U ;
VALAVANIS, A ;
AEPPLI, U ;
MAKEK, MS .
LARYNGOSCOPE, 1989, 99 (04) :429-437
[3]   Nasopharyngeal angiofibroma:: True neoplasm or vascular malformation? [J].
Beham, A ;
Beham-Schmid, C ;
Regauer, S ;
Auböck, L ;
Stammberger, H .
ADVANCES IN ANATOMIC PATHOLOGY, 2000, 7 (01) :36-46
[4]   Juvenile nasopharyngeal angiofibroma: A Systematic Review and Comparison of Endoscopic, Endoscopic-Assisted, and Open Resection in 1047 Cases [J].
Boghani, Zain ;
Husain, Qasim ;
Kanumuri, Vivek V. ;
Khan, Mohemmed N. ;
Sangvhi, Saurin ;
Liu, James K. ;
Eloy, Jean Anderson .
LARYNGOSCOPE, 2013, 123 (04) :859-869
[5]  
Borghei Peyman, 2006, Ear Nose Throat J, V85, P740
[6]   NASOPHARYNGEAL ANGIOFIBROMAS - STAGING AND MANAGEMENT [J].
CHANDLER, JR ;
MOSKOWITZ, L ;
GOULDING, R ;
QUENCER, RM .
ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 1984, 93 (04) :322-329
[7]   Juvenile Nasopharyngeal Angiofibroma: Does the External Approach Still Make Sense? [J].
Cloutier, Tam ;
Pons, Yoann ;
Blancal, Jean-Philippe ;
Sauvaget, Elisabeth ;
Kania, Romain ;
Bresson, Damien ;
Herman, Philippe .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2012, 147 (05) :958-963
[8]   Graduated Endoscopic Multiangle Approach for Access to the Infratemporal Fossa: A Cadaveric Study with Clinical Correlates [J].
Eloy, Jean Anderson ;
Murray, Kim P. ;
Friedel, Mark E. ;
Tessema, Belachew ;
Liu, James K. .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2012, 147 (02) :369-378
[9]  
Eloy P, 2007, RHINOLOGY, V45, P24
[10]  
Enepekides Danny J, 2004, Curr Opin Otolaryngol Head Neck Surg, V12, P495, DOI 10.1097/01.moo.0000143970.19992.64