Exclusively Endoscopic Surgery for Juvenile Nasopharyngeal Angiofibroma

2007 ◽  
Vol 137 (3) ◽  
pp. 492-496 ◽  
Author(s):  
Nilvano A. Andrade ◽  
José Antonio Pinto ◽  
Mônica de Oliveira Nóbrega ◽  
José Estelita P. Aguiar ◽  
Tâmara Ferraro A.P. Aguiar ◽  
...  
Keyword(s):  
Study Design ◽  
Endoscopic Surgery ◽  
Chart Review ◽  
Arterial Embolization ◽  
Residual Tumor ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Nasopharyngeal Angiofibroma ◽  
Design Chart

OBJECTIVE: To present the indications of nasal endoscopic surgery for treating juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN: Chart review. MATERIALS AND METHODS: Twelve patients underwent nasal endoscopic surgery exclusively to resect JNA from January 2001 to June 2004. According to the classification of Andrews et al, eight patients were stage I and four patients were stage II. RESULTS: The follow-up was between five and 42 months, and no patient has shown a residual tumor or recurrence to date. CONCLUSION: In JNA stages I and II, the endoscopic approach was effective without preoperative arterial embolization. There were no residual tumors or recurrence in this study. SIGNIFICANCE: It seems to be appropriate to reevaluate the surgical limits of endoscopic surgery for resecting JNA.

Classification of Surgical Complications

2017 ◽  
Author(s):  
Andrew Gonzalez ◽  
SreyRam Kuy
Keyword(s):  
Length Of Stay ◽  
Study Design ◽  
Surgical Complications ◽  
Clinical Case ◽  
Classification Model ◽  
Design Study ◽  
Study Intervention

This landmark paper proposed a graded classification model for surgical complications and determined that there is a direct correlation between complication grade and patient length of stay. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Juvenile nasopharyngeal angiofibroma with intracranial extension – diagnosis and treatment.

2019 ◽  
Vol 73 (6) ◽  
Author(s):  
Wiesław Gołąbek ◽  
Anna Szymańska ◽  
Marcin Szymański ◽  
Elżbieta Czekajska-Chehab ◽  
Tomasz Jargiełło
Keyword(s):  
Infratemporal Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Radiological Findings ◽  
Superior Orbital Fissure ◽  
Nasopharyngeal Angiofibroma ◽  
Therapeutic Modalities ◽  
Stage Ivb ◽  
Extensive Involvement

Introduction This retrospective study analyzes radiological findings, therapeutic management and outcomes of patients with intracranial extension of juvenile nasopharyngeal angiofibroma (JNA). The routes of intracranial spread, incidence of intracranial disease and influence on therapeutic approach are discussed. Material and methods An evaluation on the records of 62 patients with JNA was performed and 10 patients with intracranial tumors were included in the study. All patients were males aged 10 to 19 years. Results According to Andrews' classification 8 patients presented with stage IIIb, 1 patient stage IVa and another patient stage IVb tumor. Intracranial invasion was extradural in 8 cases and intradural in 2 patient. Surgery was performed in 9 cases and the most common was combined approach: infratemporal fossa and sublabial transantral. One patient was referred for radiotherapy. Follow-up ranged from 8 to 26 years. There was extracranial recurrence in 2 (22%) of 9 operated patients. Conclusions The superior orbital fissure is the most frequent route of intracranial spread in patients with extensive involvement of the infratemporal fossa. Due to high risk of recurrence and potential serious complications advanced cases of JNA should be managed by experienced multidisciplinary team, preferably in tertiary referral centers, with an access to modern diagnostic and therapeutic modalities.

scholarly journals Surgical management of juvenile nasopharyngeal angiofibroma using lateral rhinotomy: study of 80 cases

2011 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Ninad Gaikwad ◽  
Nilam Sathe ◽  
Abhijeet Bhatia ◽  
Dhanashree Chiplunkar ◽  
Manoj Patil
Keyword(s):  
Infratemporal Fossa ◽  
The Body ◽  
The Other ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Lateral Rhinotomy ◽  
Temporal Fossa ◽  
Nasopharyngeal Angiofibroma ◽  
Lateral Skull Base ◽  
Operative Complications

A series of 80 patients with histopathologically confirmed juvenile nasopharyngeal angiofibroma were treated surgically over a period of ten years (1995-2004). The lateral rhinotomy approach was used to expose the tumor and its extensions. Lateral rhinotomy with its extensions provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and temporal fossa. Most intracranial, extradural extensions can also be approached. There were no major operative or post-operative complications. Longterm follow up from one to ten years showed only 8 recurrences. The added advantage of this approach is that it can be combined with all the other anterior and lateral skull base approaches. The cosmetic outcome is satisfactory if nasal aesthetic subunits are taken into considerations while making the incision. The lateral rhinotomy approach is the most direct route to the body of the tumor and can be used to approach all the possible extensions of the tumor.

scholarly journals Removal of Angiofibroma with Maxillary and Mandibular Swing: A Clinical Report

2012 ◽  
Vol 4 (3) ◽  
pp. 151-155
Author(s):  
Chetan V Ghorpade ◽  
Ravi P Deo ◽  
Raghuji D Thorat ◽  
Snigdha D Devane
Keyword(s):  
Good Control ◽  
Vascular Tumor ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Clinical Report ◽  
Nasopharyngeal Angiofibroma ◽  
Local Infiltration ◽  
Visible Scar ◽  
Mandibular Swing ◽  
Maximum Exposure

ABSTRACT Juvenile nasopharyngeal angiofibroma is vascular tumor found in adolescent males. With development of endoscopic fraternity, tumor can be addressed successfully with endoscopic approach; but one needs maximum exposure for large angiofibroma with local infiltration around. Maxillary and mandibular swing technique for removal of the tumor gives excellent exposure and good control on vascularity of the tumor. Postoperative follow-up for 1 year has shown minimal visible scar, cosmetic deformity in the patient. How to cite this article Ghorpade CV, Deo RP, Thorat RD, Devane SD. Removal of Angiofibroma with Maxillary and Mandibular Swing: A Clinical Report. Int J Otorhinolaryngol Clin 2012;4(3):151-155.

scholarly journals New Strategy for Minimally Invasive Endoscopic Surgery to Treat Infectious Spondylodiscitis in the Thoracolumbar Spine

2019 ◽  
Vol 3 (22;3) ◽  
pp. 281-293
Author(s):  
Hsien-Te Chen
Keyword(s):  
Minimally Invasive ◽  
Antibiotic Treatment ◽  
Study Design ◽  
Endoscopic Surgery ◽  
Thoracolumbar Spine ◽  
High Morbidity ◽  
Endoscopic Discectomy ◽  
New Strategy ◽  
Infectious Spondylodiscitis

Background: Eradicating infection, protecting neurologic function, and maintaining structural alignment are the 3 objectives of treatment for infectious spondylodiscitis. For some patients, surgery may be necessary to achieve these goals; however, open surgeries are associated with high morbidity and mortality in elderly patients and those with multiple comorbidities. Endoscopic surgery provides a minimally invasive surgical option for obtaining a culture sample to aid identification of pathogens, while also providing a route for adequate decompression and drainage. The clinical results of this study were analyzed. Objectives: To evaluate the efficacy and safety of spinal endoscopic surgery, the basic characteristics of patients analyzed and their inflammatory markers, pain levels, and local kyphotic angles were recorded before surgery and at regular intervals after surgery. The patients’ cultured pathogens and previous antibiotic treatments were also recorded and analyzed. Study Design: Retrospective observational study (institutional review board: CMUH 105-REC2-101). Setting: Inpatient surgery center. Methods: From October 2006 to March 2017, of 508 patients who received spinal endoscopic surgery, 60 with infectious spondylodiscitis were treated using this new strategy. All 60 patients underwent plain film radiography and enhanced magnetic resonance imaging of the affected region to obtain evidence of infectious spondylodiscitis. The role of a computed tomographyguided biopsy and some indications for open surgery were replaced with endoscopic surgery. Results: All the patients reported rapid pain relief after endoscopic surgery and antibiotic treatment. No significant changes in sagittal alignment were observed in final follow-up radiography images. Causative pathogens were identified in 34 patients (culture rate: 77.27%) without previous antibiotic treatment. The patients’ erythrocyte sedimentation rates and C-reactive protein levels had decreased significantly 3 months after endoscopic surgery. Two patients (3.3%) experienced infection relapse following initial endoscopic surgery; both of them were efficiently resolved through a second round of endoscopic surgery. No surgeryrelated complications were observed and no open spinal surgery was required during the follow-up period. Limitations: This was a retrospective study; bias was unavoidable because of the singlecenter nature of the study design. Conclusions: Regarding the culture rate, recurrence rate, kyphotic change, and surgeryrelated complications, this new strategy for endoscopic surgery is safe and effective for treating infectious spondylodiscitis in the thoracic or lumbar spine and may be considered a new trend in treating diseases of this type. Key words: Spine, endoscopic, discectomy, spondylodiscitis, minimally invasive surgery

Transnasal microscopic approach for juvenile nasopharyngeal angiofibroma

2018 ◽  
Vol 72 (5) ◽  
pp. 31-36 ◽  
Author(s):  
Wiesław Gołąbek ◽  
Anna Szymańska ◽  
Kamal Morshed
Keyword(s):  
Infratemporal Fossa ◽  
Surgical Excision ◽  
Vascular Tumor ◽  
Stage I ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Stage Iiia ◽  
Nasopharyngeal Angiofibroma ◽  
Feeding Vessels

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor originating in the nasopharynx. The treatment of choice for JNA is surgical excision. In recent years, surgical management has been greatly influenced by the use of the transnasal endoscopic technique. The aim: The aim of the study was to present our experience with the transnasal microscopic removal of JNA. Material and methods: Ten patients with JNA aged 12-17 underwent diagnostics imaging and transnasal microscopic tumor excision. Medical records of patients were retrospectively reviewed. The main outcome measures were complications and recurrences. Preoperative embolization of feeding vessels was performed in 7 patients. Results: According to Andrews’ classification, the group included 2 stage I patients, 6 stage II patients and 2 stage IIIA patients with the extensive occupation of the infratemporal fossa. 9 patients had no recurrence in 6-11 years follow up. One stage IIIA patient had a recurrence posteriorly to the pterygopalatine process and it was completely removed. No complications during or after surgery occurred. Conclusion: Transnasal microscopic excision is an effective approach to resect stage I-IIIA JNA

scholarly journals Morbidity and Volumetric Progression in Juvenile Nasopharyngeal Angiofibroma in a Long-Term Follow-Up

2018 ◽  
Vol 79 (06) ◽  
pp. 533-537 ◽  
Author(s):  
Marc Mosimann ◽  
Domenic Vital ◽  
David Holzmann ◽  
Lorenz Epprecht
Keyword(s):  
Residual Tumor ◽  
Open Approach ◽  
Nasopharyngeal Angiofibroma ◽  
Symptomatic Recurrence ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time ◽  
Over Time

Objective We compare the open and transnasal approaches for the excision of juvenile nasopharyngeal angiofibromas regarding the rate of morbidity, and residual tumor and its symptomatic recurrence over time. In addition, we present volumetric measurements of juvenile nasopharyngeal angiofibromas over time. Methods All surgically treated patients of our institution were reviewed back to 1969 for type of surgery, residual tumor by magnetic resonance imaging (MRI)-based volumetry, recurrence, and morbidity. We performed a prospective clinical and radiological follow-up on reachable patients. Results In total, 40 patients were retrievable from our records. We were able to follow up on 13 patients after a mean of 15.7 years since surgery (range: 1–47 years). Patients operated by the open approach had a higher rate of postoperative complications and thus a higher morbidity than endoscopic patients (4/4 vs 3/9; p = 0.007), although tumor sizes were equal among groups (p = 0.12). Persisting tumor was noted in 3/4 and 4/9 (p = 0.56) patients, respectively. The corresponding mean volumes of residual tumors were 16.2 ± 14.4 cm3 and 10.8 ± 6.6 cm3 (p = 0.27). No progression could be noted in endoscopically treated patients (p = 0.24, mean time between scans 2 years). Conclusions Our analysis shows that the endoscopic approach results in less morbidity. The open approach does not guarantee freedom from persisting tumor tissue. Age seems to be a most important risk factor for the conversion of an asymptomatic persistence into a symptomatic recurrence.

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