Innovative Approach to Surgical Treatment for Locally Advanced Cancer of Paranasal Sinus and Nasal Cavity

2021 ◽  
Vol 76 (3) ◽  
pp. 317-323
Author(s):  
Oleg I. Kit ◽  
Igor V. Reshetov ◽  
Marina A. Engibaryan
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Control Group

Background. Despite the rapid oncology development, the problem of surgical treatment for locally advanced tumors of the paranasal sinus and nasal cavity is still relevant. The search and development of ways to improve the surgical approach, including modern endovascular methods, appears necessary. Aims development and evaluation of the effectiveness of an innovative approach to the surgical treatment of malignant tumors of the nasal cavity and paranasal sinus with superselective intra-arterial embolization as a preparatory stage. Materials and methods. The study is based on the treatment outcomes of 52 patients with cancer of the nasal cavity and paranasal sinus. The main group included 21 patients receiving treatment with our developed approach including preoperative superselective intra-arterial embolization as a preparatory stage for surgical treatment. The control group included 31 patients receiving standard surgical treatment with traditional ligation of the external carotid artery at the first stage. Estimation of the amount of intraoperative blood loss with gravimetric analysis was considered the primary endpoint of the study. Post-embolization syndrome manifestations were analyzed by evaluating the pain intensity with a visual analogue scale and thermometry. Results. Intraoperative blood loss in patients of the main group varied from 100 to 400 ml, being on average 231.9100.58 ml. In the control group, the blood loss varied from 300 ml to 1000 ml, on average 630.97190.23. The data analysis proved demonstratively the effectiveness of the developed approach to surgical treatment of locally advanced tumors of the nasal cavity and paranasal sinus, since it statistically significantly reduced the amount of intoperative blood loss (p 0.005). Conclusions. Our developed approach to the treatment for malignant tumors of the paranasal sinus and nasal cavity optimized the results of surgical treatment and statistically significantly reduced the amount of intoperative blood loss, compared to the traditional ligation of the external carotid artery, from 630.97190.23 to 231.9100.58 ml (p 0.005), with minimal manifestations of post-embolization syndrome.

scholarly journals Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

2021 ◽  
Vol 10 (17) ◽  
pp. 3926
Author(s):  
Andrea Giorgianni ◽  
Stefano Molinaro ◽  
Edoardo Agosti ◽  
Alberto Vito Terrana ◽  
Francesco Alberto Vizzari ◽  
...  
Keyword(s):  
Blood Loss ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

External carotid-cavernous fistula treated by arterial embolization

1974 ◽  
Vol 40 (1) ◽  
pp. 110-114 ◽  
Author(s):  
M. Stephen Mahalley ◽  
Stephan C. Boone
Keyword(s):  
Carotid Artery ◽  
Successful Treatment ◽  
Arterial Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Unusual Occurrence ◽  
Fine Print

✓ The unusual occurrence of a carotid-cavernous fistula supplied entirely by branches of the external carotid artery is presented, and its successful treatment by arterial embolization described.

Feasibility and efficacy of weekly intraarterial cisplatin in locally advanced (stage III and IV) head and neck cancers.

1988 ◽  
Vol 6 (6) ◽  
pp. 969-975 ◽  
Author(s):  
J E Mortimer ◽  
M E Taylor ◽  
S Schulman ◽  
C Cummings ◽  
E Weymuller ◽  
...  
Keyword(s):  
Head And Neck ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Complete Response ◽  
External Carotid Artery ◽  
Head And Neck Cancers ◽  
External Carotid ◽  
Nodal Disease ◽  
Primary Tumor Site ◽  
Primary Tumors

Thirty-five consecutive patients with primary unresectable head and neck cancers were considered eligible for protocol treatment with neoadjuvant intraarterial cisplatin. External carotid artery catheterizations were technically feasible in 29 patients (83%). Twenty-five patients with 28 primary tumors received intraarterial cisplatin, 100 mg/m2, every seven to 14 days for three cycles. The most common toxicity was nausea and vomiting. Ipsilateral hemialopecia, transient VII nerve palsy, and blurring of vision seem to be unique to this route of administration at this dose. A complete response was seen at the primary tumor site in nine of 28 (32%), with 14 of 28 partial responses (50%). In evaluating both primary tumor and nodal disease, five of 25 patients achieved a complete response and 15 of 25 a partial response. In previous reports, one complete response was observed in 74 patients with head and neck cancer treated with neoadjuvant intravenous (IV) cisplatin every 3 weeks. The overall response of 82% reported here is comparable to that reported with combination chemotherapy and suggests an advantage to the arterial administration of cisplatin when possible in the neoadjuvant setting.

Regional Cancer Chemotherapy of Head and Neck Tumors by Continuous Intraarterial Infusion

1964 ◽  
Vol 50 (4) ◽  
pp. 267-308 ◽  
Author(s):  
Sergio Di Pietro ◽  
Leandro Gennari
Keyword(s):  
Carotid Artery ◽  
Anticancer Drugs ◽  
Malignant Tumors ◽  
Superficial Temporal Artery ◽  
External Carotid Artery ◽  
Facial Artery ◽  
External Carotid ◽  
Lingual Artery ◽  
Arterial Infusion ◽  
Vascular Area

The results of treatment through continuous arterial infusion of anticancer drugs in 40 patients with malignant tumors, localized in the vascular area of the external carotid artery, are reported. Most of carcinomas belonged to the oral and pharingeal cavities. The external carotid artery was catheterized directely in 5 cases and indirectely in 28 cases (mostly through the superficial temporal artery); in 6 cases the lingual artery and in 3 cases the facial artery were used. The drugs and total doses employed were as follows: amethopterin (30–150 mg in 10 cases), triethylen-thiophosphoramide (60–300 mg in 9 cases), cyclophosphamide (800–6000 mg in 8 cases), daunomycin (40–280 mg in 8 cases), mitomycin C (20–40 mg in 2 cases), nitrogen mustard (10 mg in 2 cases), busulfan (35 mg in 1 case). The arterial infusion lasted from a minimum of 4 hours to a maximum of 14 days with an average of 6–12 days. In 19 cases (46,5 %) an objective improvement with significant but incomplete regression of the tumor was obtained. The improvement lasted from a minimum of 1 month to a maximum of 8 months. In this study, amethopterin was the most active compound, but only slightly more active than cyclophosphamide and daunomycin. Six patients died because of complications secondary to therapy. The indications and the technique of arterial infusion with anticancer drugs in tumors of the vascular area of the external carotid artery are discussed, as well as the complications related with this type of treatment. The literature about this subject is also reviewed.

scholarly journals Maxillary Antrum Carcinoma - A Wolf in Sheep’s Clothing

2021 ◽  
Vol 10 (33) ◽  
pp. 2870-2873
Author(s):  
Romita Gaikwad ◽  
Pranada Deshmukh ◽  
Ramhari Sathawane ◽  
Ashish Lanjekar
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Maxillary Antrum ◽  
Locally Advanced ◽  
Neck Region ◽  
Advanced Stage ◽  
Malignant Tumours ◽  
The Right

Maxillary sinus squamous cell carcinoma is an invasive tumour that is usually diagnosed at an advanced stage, where the majority of patients have a very low prognosis and survival rate. We present a case of maxillary sinus carcinoma that affected the entire orbit, resulting in proptosis of the eye and nasal cavity. The patient was recommended for palliative treatment due to the high degree of its involvement and proximity to vital structures. It manifests with very mild to no signs, resulting in a late diagnosis. As a result, physicians must be mindful of maxillary sinus pathologies to make an early diagnosis. Paranasal sinuses are air-filled spaces located close to vital structures such as visual organs and the face. Maxillary, ethmoidal, frontal, and sphenoidal are the 4 paranasal sinuses that are named according to the bones in which they are situated. Nasal cavity and paranasal air sinus malignancies are uncommon. According to the literature, paranasal sinus malignancies account for less than 1 % of all human malignancies and 3 % of the total malignancies of the head and neck region. However, the maxillary sinus is the most frequent site of origin of primary malignant tumours amongst the paranasal sinuses.1 we need to raise general awareness among the oral stomatologists as Asian countries report a very high incidence of maxillary sinus carcinoma.2 The incidence of malignancies in maxillary sinus is high (60 % - 70 %) and less in the nasal cavity (12 % - 25 %), the Ethmoid (10 % - 15 %) and very rare in sphenoid / frontal sinuses (1 %).3 Further, not only the malignancies of maxillary sinuses are common, but they also incur the worst prognosis. Maxillary sinus carcinomas have very few symptoms and are similar to those of chronic paranasal sinusitis. They usually present themselves as locally advanced diseases. 4,5 Paranasal sinus malignancies are difficult to diagnose in the early stages and 90 % of cases are reported in T3 / T4 advanced stage.6 Environmental factors such as industrial pollutants, dust, smoke, and adhesives are the leading causes for the development of disease.7 Thus, sinonasal malignant tumours are rare and pose a challenge in diagnosis as well as treatment. Therefore, maxillofacial specialists should be aware of the signs and symptoms of this rarely occurring disease. This article presents a rare case of a 45-year-old female who reported to our OPD with a complaint of swelling in the right zygomatic area and proptosis of the right eye.

scholarly journals Extreme blood loss in cancer surgery: is it a verdict to the patient or a challenge to the staff?

2019 ◽  
Vol 10 (3) ◽  
pp. 42-48 ◽  
Author(s):  
Pavel I. Feoktistov ◽  
I. E. Кarmanov
Keyword(s):  
Blood Loss ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Venous Access ◽  
Multiple Organ ◽  
Early Postoperative Period ◽  
Cancer Surgery ◽  
Septic Complications ◽  
Massive Blood Loss ◽  
Combined Operations

Background. The development of anesthesiology allows performing combined operations in patients with locally advanced malignant tumors. A logical companion of aggressive cancer surgery is a massive blood loss, which can be so pronounced that it poses a threat to the life of the patient. Objective. The presented experience is an example of transformation of a nearly fatal situation into a curable one and can be useful in choosing an active treatment strategy in most desperate situations. Methods. This research includes 25 patients with the blood loss of 20 liters or more during surgery. Results. The median ratio of infusion to blood loss was 133%, and the ratio of the infusion to all fluid losses amounted to 118%. In 100% of cases, catecholamines were used to support the blood circulation: one drug used in 12% of observations and two to five drugs used in 88% of observations. 2 patients died during the operation. 5 patients died in the early postoperative period from multiple organ failure. The cause of death of another 5 patients was septic complications before the 28th post-op day. Discussion. Performing operations accompanied by acute massive blood loss requires an effective anesthetic support. Conclusions. Enforcement of certain diagnostic and therapeutic conditions (stage construction of anesthesia, hemodynamic and laboratory monitoring, adequate venous access, rational infusion, timely use of catecholamines, using cell-saver device) in the majority of cases allows completing the operation with the surgical control of hemostasis and successfully enduring traumatic and complicated surgery in half of cases.

Infusion-transfusion therapy in the treatment of acute massive surgical blood loss in cancer surgery

2021 ◽  
Author(s):  
П.И. Феоктистов ◽  
А.Р. Шин ◽  
А.О. Приходченко ◽  
П.В. Вяткин ◽  
Е.Н. Феоктистова
Keyword(s):  
Blood Loss ◽  
Large Scale ◽  
High Efficiency ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Cancer Surgery ◽  
Quantitative Composition ◽  
Transfusion Therapy ◽  
Circulating Blood Volume ◽  
Somatic Status

Введение. Расширенные комбинированные вмешательства являются основным методом лечения пациентов с местнораспространенными солидными злокачественными опухолями. Основным следствием масштабной онкохирургии является риск развития острой массивной кровопотери (ОМОК). Цель исследования: оценка переносимости ОМОК у онкологических больных. Материалы и методы. В одноцентровое ретроспективное исследование с января 1999 г. по декабрь 2018 г. были включены 4236 больных, оперированных в радикальном объёме по поводу злокачественных опухолей различных локализаций, течение операции у которых осложнилось ОМОК. Критерием ОМОК являлась потеря ≥ 50% от расчётного объёма циркулирующей крови (ОЦКр) в течение 3 ч операции. Пациенты, вошедшие в исследование, были разделены на 4 группы в зависимости от объёма кровопотери: от 51 до 100%, от 101 до 200%, от 201 до 300% и свыше 300% ОЦКр. Результаты. Пациенты исследованных групп не различались ни по общим показателям, ни по исходному соматическому статусу. Про анализированы качественный и количественный состав инфузионно-трансфузионной терапии (ИТТ), показатели баланса жидкости интраоперационно, продолжительность пребывания пациентов в отделении реанимации и интенсивной терапии, летальность. Заключение. Соблюдение определенного протокола ИТТ при онкологических операциях, осложнённых ОМОК, является залогом успешного лечения и позволяет снизить интраоперационную летальность до 0,8% и госпитальную летальность до 6,45%. Метод аппаратной реинфузии аутоэритроцитов продемонстрировал высокую эффективность. Background. Cancer surgery remains the backbone of treatment approaches in patients with locally advanced solid malignancies. Risk of acute massive blood loss (AMBL) remains the main complication of such large-scale cancer surgery. Objectives: assessment of AMBL tolerance in cancer patients. Patients/Methods. A single- center retrospective study from January 1999 to December 2018 included 4,236 patients who underwent radical surgery for malignant tumors of various localizations, whose course of surgery was complicated with AMBL. The AMBL criterion was the loss of ≥ 50% of the calculated circulating blood volume (СBVс) within 3 hours of the operation. The patients included in the study were divided into 4 groups depending on the volume of blood loss: from 51 to 100%, from 101 to 200%, from 201 to 300% and over 300% of СBVс. Results. Patients of the studied groups did not differ either in general parameters or in baseline somatic status. The qualitative and quantitative composition of infusion-transfusion therapy (ITT), intraoperative fluid balance, patients stay in the intensive care unit, and mortality were analyzed. Conclusions. Compliance with a specific ITT protocol during cancer surgery complicated by AMBL is the key to successful treatment and allows to reduce intraoperative mortality to 0.8% and hospital mortality to 6.45%. The method of intraoperative red cell salvage and autologus transfusion has demonstrated high efficiency.

Combined Modality Treatment Including Neutron Therapy for Tumors of the Nasal Cavity and Paranasal Sinuses

2015 ◽  
Vol 1084 ◽  
pp. 365-368
Author(s):  
Valerij Novikov ◽  
Ludmila Musabaeva ◽  
Olga Gribova
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Fast Neutrons ◽  
Combined Modality Treatment ◽  
Free Survival ◽  
Combined Modality

The study group comprised 91 patients with nasal cavity cancer and paranasal sinuses cancer who received the combined modality treatment with the use of 6.3 MeV fast neutrons generated within U-120 cyclotron. The method of combined modality treatment for locally advanced malignant tumors of the nasal cavity and paranasal sinuses was found to be more effective compared to the conventional treatment in terms of the 5-year overall and disease-free survival rates.

Experimental investigation of encephalomyosynangiosis using gyrencephalic brain of the miniature pig: histopathological evaluation of dynamic reconstruction of vessels for functional anastomosis

2009 ◽  
Vol 3 (6) ◽  
pp. 488-495 ◽  
Author(s):  
Mitsunobu Nakamura ◽  
Hideaki Imai ◽  
Kenjiro Konno ◽  
Chisato Kubota ◽  
Koji Seki ◽  
...  
Keyword(s):  
Cerebral Cortex ◽  
Carotid Artery ◽  
Histological Examination ◽  
Initial Step ◽  
Scar Tissue ◽  
External Carotid Artery ◽  
External Carotid ◽  
Control Group ◽  
Miniature Pig ◽  
Temporal Muscle

Object Encephalomyosynangiosis (EMS) is a surgical treatment for moyamoya disease that is widely used to provide increased intracranial blood flow via revascularization by arterial anastomosis from the external carotid artery. However, the angiogenic mechanism responsible for the revascularization induced by EMS has not been systematically evaluated. In this study the authors investigated the chronological angiogenic changes associated with EMS to clarify the favorable factors and identify revascularization mechanisms by using an experimental internal carotid artery occlusion (ICAO) model in the miniature pig. Methods Fourteen miniature pigs were used, 11 of which underwent ICAO before transcranial surgery for EMS was performed. Animals were allowed to recover for 1 week (4 pigs) or 4 weeks (7 pigs) after EMS. Control group animals were treated in the same way, but without occlusion (3 pigs). Magnetic resonance imaging, angiography, and histological investigation were performed. Results One week after EMS, on histological examination of both the ICAO and control groups it was found that the transplanted temporal muscle had adhered to the arachnoid via a granulation zone, which was enriched with immune cells such as macrophages associated with the angiogenic process. Four weeks after EMS, angiography and histological examination of the ICAO group showed patent anastomoses between the external carotid artery and the cortical arteries without any detectable boundary between the temporal muscle and the cerebral cortex. In contrast, histological examination of the control group found scar tissue between the cerebral cortex and temporal muscle. Conclusions The initial step for formation of anastomoses resembles the process of wound healing associated with repair processes such as active proliferation of macrophages and angiogenesis within the new connective tissue. Functional revascularization requires a suitable environment (such as tissue containing vascular beds) and stimulus (such as ischemia) to induce vascular expansion.

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