Pterygopalatine/Pterygomaxillary Space Approaches, Maxillary Artery Ligation, and Approach to Juvenile Nasopharyngeal Angiofibroma

Author(s):  
Edward C. Kuan ◽  
Rakesh Chandra ◽  
Bert W. O’Malley ◽  
Nithin D. Adappa
2011 ◽  
Vol 17 (1) ◽  
pp. 13-16 ◽  
Author(s):  
A.S. Puri ◽  
R. Thiex ◽  
H. Zarzour ◽  
R. Rahbar ◽  
D.B. Orbach

We describe the occurrence of the trigeminocardiac reflex (TCR) during DMSO pre-flushing of the microcatheter in preparation for Onyx embolization via the internal maxillary artery. TCR has not been previously associated with embolization of extradural entities. Familiarity with this clinical reflex and its proper management may help in planning neurointerventional procedures involving DMSO injection in the trigeminal territory.


2020 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Lucas P Carlstrom ◽  
Jeffrey R Janus ◽  
Jamie J Van Gompel

Abstract Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular benign tumor that originates in the sphenopalatine foramen and often spreads to adjacent compartments.1 Microsurgical resection with preoperative embolization remains the treatment of choice.2 We present a case of a large JNA involving multiple compartments. The patient is a 20-yr-old male who presented with long-term right nasal congestion. The MRI demonstrated a large enhancing mass that extended from the right nasal cavity and nasopharynx into the right pterygopalatine fossa (PPF), infratemporal fossa (ITF), and parapharyngeal space. Preoperative angiogram for embolization showed a highly vascular tumor with blood supply mainly from the internal maxillary artery and about 10% from a persistent mandibular branch of the internal carotid artery. Based on the UPMC JNA staging system, this tumor was a stage IV.2 A combined anterior transmaxillary (Caldwell-Luc) with an endoscopic endonasal transpterygoid approach was performed. The addition of the anterior transmaxillary approach increases the surgical freedom for traditional bipolar devices and improves the view and trajectory to more lateral structures like the PPF and ITF.3 Gross total resection was achieved without complications. The patient was discharged home with a partial V2 numbness (right superior gum) that improved with time. The endoscopic endonasal approach is a safe and effective technique even for large JNA. A multidisciplinary team consisting of an interventional radiologist, a skull base neurosurgeon, and an otorhinolaryngologist with expertise in endoscopic surgery may play a role for optimal surgical results. The patient consented for the procedure and for the video production.


2021 ◽  
Vol 06 (03) ◽  
pp. 188-193
Author(s):  
Prasetyo Sarwono Putro ◽  
Meutia Apriani ◽  
Muchtar Hanafi ◽  
Vania Puspitasari

Diagnosis to treatment of Juvenile Nasopharyngeal Angiofibroma (JNA) required a multidisciplinary approach. CT scan works by combining multi-slice imaging from a device that rotates around the object. The potential of missing certain parts in the scanning process can occur. Angiography was the option to cover the CT scan pitfalls. In this case, we discussed CT scan pitfalls that can be overcome by angiography through JNA case report by showing clearer picture of the JNA and its feeding artery. 14 years old child complained of nasal congestion. On physical examination, the lesion expanded the anterior side of nasal cavity. The patient underwent a synonasal CT scan without contrast. It was obtained a heterogeneous solid mass in the nasopharynx extending to the concha and right and left maxillary sinuses. However, until the preparation of angiography, the actual size of the tumor, as well as the entire vasculature, is not yet known. The angiographic features suggested that the right side (seen in the right maxillary artery) was more dominant than the left side. However, both the right and the left finding reassured that the tumor location was more dominant in the anterior nasal cavity. The posterior lesion was also seen but did not predominate in comparison to the anterior. These findings helped clinicians in planning operative action in order to evacuate the tumor.


Skull Base ◽  
2007 ◽  
Vol 17 (S 2) ◽  
Author(s):  
Trevor Hackman ◽  
Carl Snyderman ◽  
Ricardo Carrau ◽  
Amin Kassam

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Philippe Herman ◽  
Romain Kania ◽  
Emmanuel Bayonne ◽  
Wissame Bakkourri ◽  
Patrice Tran Ba Huy

Sign in / Sign up

Export Citation Format

Share Document