Current trend of surgery in juvenile nasopharyngeal angiofibroma: a hospital based retro-prospective study

Background: The aim of the present study was to know the current trends of surgery, to determine the surgery of choice according to stage and complications, rate of recurrence of following surgery.Methods: Retro-prospective study was carried out from August 2004 to July 2014, in which 31 prospective and 8 prospective cases were included. All the details of patients like general examination, ENT examination, computed tomography or magnetic resonance imaging scan finding, staging, and approach of surgery, complications, and recurrence rate were recorded. Results: In our study all the patients were male and the mean age was 15.74 years (age ranged 11 to 22 years). Most frequent sign and symptoms were epistaxis (92.4%), nasal blockage (90%), and facial swelling (18%). Most common surgical approach was ‘trans palatine approach’ (51% cases) belongs to stage IIa, IIb, IIc, IIIa, IIIb and ‘lateral rhinotomy approach’ used in 35% cases. And by endoscopic approach (only 5.1% cases) were operated due to lack of embolization technique. Overall recurrence was about 29% (66% cases belonged to stage III). Postoperative complications were septal perforation 33%, palatal perforation 9.5%, facial disfiguration 9.5% and 9.5% hypertrophic scar.Conclusions: Our study we concluded that, 92% of patients age group 11 to 20 years and all were males. Epistaxis and nasal obstruction were the most common symptoms. Most of the recurrent tumor belonged to stage III tumor. Most appropriate surgical approach for stage I, IIa and IIb was transpalatine approach and for stage IIc and IIIa was lateral rhinotomy. Complete excision of intracranial extension of tumor was difficult and causes recurrence of diseases.

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Surgical Experience with Juvenile Nasopharyngeal Angiofibroma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909800406 ◽

1989 ◽

Vol 98 (4) ◽

pp. 269-272 ◽

Cited By ~ 16

Author(s):

Daya Maharaj ◽

Carlos M. C. Fernandes

Keyword(s):

Surgical Procedures ◽

Surgical Excision ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Intracranial Extension ◽

Lateral Rhinotomy ◽

Total Excision ◽

Surgical Experience ◽

Nasopharyngeal Angiofibroma ◽

Transpalatal Approach ◽

Second Procedure

Our experience with 18 cases of juvenile nasopharyngeal angiofibroma (jna) over a period of 9 years is discussed. All cases were managed surgically: 17 via a transpalatal approach and one case by a combined transpalatal, lateral rhinotomy, and transantral approach. In this series there were two recurrences following primary surgical procedures and these required a second procedure. There were no major complications and all 18 patients are alive. We believe that surgical excision should be the treatment of choice for jna and that radiotherapy should be used adjunctively for cases wherein intracranial extension of the tumors prevents total excision.

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R415 – Recurrence of Nasopharyngeal Angiofibroma (NPF) Study

Otolaryngology ◽

10.1016/j.otohns.2008.05.569 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P182-P182

Author(s):

Vardhan Vishnu ◽

R. Martha

Keyword(s):

Prospective Study ◽

Recurrence Rate ◽

Surgical Approach ◽

Statistical Difference ◽

Duration Of Symptoms ◽

Nasopharyngeal Angiofibroma ◽

Appropriate Treatment ◽

One Year ◽

The Right

Problem Study of correlation of recurrence of NPF with its histopathologic appearance. Methods A retrospective and prospective study of 184 NPF cases identified, treated in Government Ear Nose Throat Hospital, and followed over a period of 26 years (1981–2006) and their histopathological slides are preserved, their recurrence rate is documented. The histopathology of NPF is varied - composed of vascular and fibrous components and their proportion varied. In our study we will undertake the review of histopathology slides that are already preserved and would also like to study the new recurrent cases in the coming 6 months. Results All recurrences were observed with in one year of of treatment and the recurrence rate was 19.66%. Recurrence had no correlation with age of patient, duration of symptoms, or surgical approach but correlated with stage of tumor at presentation (p less than 0.05). Preoperative embolisation was done in 16.85% cases and did not show any statistical difference in recurrence rate between the embolised and non embolised. Conclusion The correlation between the histopathological appearance and the recurrence rate will help in choosing the right approach for surgery and also postoperative follow-up to detect the recurrence at the earliest. Significance Histopathological detail can help in knowing the prognosis in terms of chances of recurrence and also guide for follow up at close intervals and advocate the appropriate treatment at the earliest.

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Removal of Intracranial Extension of Juvenile Nasopharyngeal Angiofibroma by the Transfacial Approach

Skull Base ◽

10.1055/s-2007-984092 ◽

2007 ◽

Vol 17 (S 1) ◽

Author(s):

Philippe Herman ◽

Romain Kania ◽

Emmanuel Bayonne ◽

Wissame Bakkourri ◽

Patrice Tran Ba Huy

Keyword(s):

Juvenile Nasopharyngeal Angiofibroma ◽

Intracranial Extension ◽

Nasopharyngeal Angiofibroma

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Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1718767 ◽

2020 ◽

Author(s):

Ravi Sankar Manogaran ◽

Raj Kumar ◽

Arulalan Mathialagan ◽

Anant Mehrotra ◽

Amit Keshri ◽

...

Keyword(s):

Skull Base ◽

Surgical Approach ◽

Nerve Palsy ◽

Tertiary Care ◽

Surgical Approaches ◽

Microsurgical Anatomy ◽

Complete Excision ◽

Lateral Skull Base ◽

The Individual ◽

Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

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Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1725031 ◽

2021 ◽

Author(s):

Salomon Cohen-Cohen ◽

Kristen M. Scheitler ◽

Garret Choby ◽

Jeffrey Janus ◽

Eric J. Moore ◽

...

Keyword(s):

Surgical Management ◽

Intracranial Extension ◽

Preoperative Embolization ◽

Tumor Diameter ◽

Historical Cohort ◽

Nasopharyngeal Angiofibroma ◽

Estimated Blood Loss ◽

The Impact ◽

Previous Series

Abstract Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures. Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center. Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort. Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.

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Tumor Tissue MIR92a and Plasma MIRs21 and 29a as Predictive Biomarkers Associated with Clinicopathological Features and Surgical Resection in a Prospective Study on Colorectal Cancer Patients

Journal of Clinical Medicine ◽

10.3390/jcm9082509 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2509

Author(s):

Masahiro Fukada ◽

Nobuhisa Matsuhashi ◽

Takao Takahashi ◽

Nobuhiko Sugito ◽

Kazuki Heishima ◽

...

Keyword(s):

Colorectal Cancer ◽

Prospective Study ◽

Surgical Resection ◽

Tumor Tissue ◽

Lymphatic Invasion ◽

Clinicopathological Features ◽

Stage Iii ◽

Sample Type ◽

Significant Difference ◽

A Prospective Study

Cancer-related microRNAs (miRNAs) are emerging as non-invasive biomarkers for colorectal cancer (CRC). This study aimed to analyze the correlation between the levels of tissue and plasma miRNAs and clinicopathological characteristics and surgical resection. This study was a prospective study of CRC patients who underwent surgery. Forty-four sample pairs of tissue and plasma were analyzed. The miRNA levels were evaluated by RT-qPCR. The level of tumor tissue MIR92a showed a significant difference in CRC with lymph node metastasis, stage ≥ III, and high lymphatic invasion. In preoperative plasma, there were significant differences in CRC with stage ≥ III (MIR29a) and perineural invasion (MIR21). In multivariate analysis of lymphatic invasion, the levels of both preoperative plasma MIR29a and tumor tissue MIR92a showed significant differences. Furthermore, in cases with higher plasma miRNA level, the levels of plasma MIRs21 and 29a were significantly decreased after the operation. In this study, there were significant differences in miRNAs levels with respect to the sample type, clinicopathological features, and surgical resection. The levels of tumor tissue MIR92a and preoperative plasma MIR29a may have the potential as a biomarker for prognosis. The plasma MIRs21 and 29a level has the potential to be a predictive biomarker for treatment efficacy.

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Abstract 1122‐000193: Intracranial Bleeding in a Juvenile Nasopharyngeal Angiofibroma Stage IVb

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000193 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Laura M Sanchez‐Garcia ◽

Gustavo Melo‐Guzman ◽

Denise G Arechiga‐Navarro ◽

Juan I Ramirez‐Rodriguez

Keyword(s):

Carotid Artery ◽

Intracranial Extension ◽

External Carotid ◽

Nasopharyngeal Angiofibroma ◽

Trigeminocardiac Reflex ◽

Anticholinergic Therapy ◽

Recurrent Epistaxis ◽

Stage Ivb ◽

Diagnostic Catheter ◽

Stimulation Of

Introduction : The trigeminocardiac reflex has been reported in craniofacial, neurosurgery, ophthalmological surgeries, and recently at endovascular procedures. Therefore, it has been called by other names also as trigeminal depressor reflex, reflex vagal trigeminal, or oculocardiac reflex. It is provoked by the stimulation of branches of the trigeminal nerve and presents cardiovascular alterations such as hypotension, bradycardia, cardiac arrhythmias, which can lead to asystole. This reflex originates at the brainstem and occurs as a rare autonomic dysfunction triggered by the stimulation of baroreceptors. Some factors predispose the appearance of this type of reflex, such as hypercapnia, hypoxemia, superficial anesthetic depth, and acidosis, among others. During these procedures is recommended continuous monitoring of the ECG and PAM. It is always essential to know the patient and modify the risk factors, or even stop the stimulus notifying the surgeon, if there is no adequate response, anticholinergic therapy, such as atropine, and the use of vasopressors should be applied. Methods : We report a clinical case of an 18‐year‐old male with a history of 3 years of recurrent epistaxis diagnosed with a Juvenilenasopharyngeal angiofibroma stage IVB, who underwent diagnostic cerebral angiography for surgical planning. Results : Angiography was performed under conscious sedation. When we placed the JB2 diagnostic catheter in the external carotid artery, the patient presented bradycardia of 40bpm. The catheter was removed, and the heart rate improved; we made a second attempt again with bradycardia, for which atropine was administered, and continued with the procedure without incident. We evaluated the vascular supply to the tumor and ruled out the involvement of the ipsilateral internal carotid artery. An occlusion test was also performed, which was positive. No aneurysms were found during angiography. At the end of the angiography, the patient presented anisocoria and left hemiparesis, so due to the suspicion of a thromboembolic event, a new femoral approach was performed to assess the intracranial circulation we found adequate patency. A non‐contrast head CT was performed, a subarachnoid hemorrhage in the prepontine and the interpeduncular cistern was observed. Medications used for sedation were discontinued to assess his neurological status at that time with GCS of 12. 48 hrs later, the patient was neurologically intact and without sequelae. In the literature review, we did not find reports of intracranial hemorrhage as complications in nasopharyngeal angiofibroma with intracranial extension or secondary to the presentation of the trigeminocardiac reflex. However, we suspected that it could result from a transient elevation of arterial hypertension due to the administration of anticholinergic therapy. Conclusions : Neuroanesthesiologists and endovascular surgeons must be aware of its manifestations and management to avoid complications due to the presentation of this reflex.

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Sphenochoanal Polyp - "The Forgotten Element?"

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2021.v29i2.371 ◽

2021 ◽

Vol 29 (2) ◽

pp. 209-212

Author(s):

Misbahul Haque ◽

Subhrajit Das ◽

Subrata Mukhopadhyay

Keyword(s):

Case Report ◽

Nasal Obstruction ◽

Surgical Approach ◽

Surgical Intervention ◽

Complete Removal ◽

Endoscopic Polypectomy ◽

Complete Excision ◽

Sphenochoanal Polyp

Introduction The occurrence of isolated spheno-choanal polyps are not very common and can be very well confused with antro-choanal polyps or adenoids in adolescents and children. Appropriate diagnosis and prompt surgical intervention are essential for its removal. Case Report We report one such case of a 16 year old female who presented with complaints nasal obstruction and reduced hearing. Endoscopic polypectomy was done with complete removal of the polyp. Discussion Sphenochoanal Polyp is often misdiagnosed and proper investigations are thus essential for its diagnosis. Surgical Approach is the mainstay form of treatment with complete excision of the polyp.

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