scholarly journals Resection of a juvenile nasopharyngeal angiofibroma via a hybrid cranioendoscopic approach

2020 ◽  
Vol 2 (2) ◽  
pp. V17
Author(s):  
Evan Joyce ◽  
Michael Karsy ◽  
Serge Makarenko ◽  
Jeramiah Alt ◽  
Richard Orlandi ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Pediatric Patients ◽  
Middle Cranial Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Nasopharyngeal Angiofibroma ◽  
Pediatric Tumor ◽  
Microsurgical Approach ◽  
Cranial Fossa ◽  
Neurovascular Structures ◽  
Complex Lesions

Endoscopic and open microsurgical approaches for pediatric patients are useful for a wide variety of skull base pathologies. A hybrid, cranioendoscopic approach may be beneficial in improving surgical resection for complex lesions. A case of a 13-year-old boy with a large juvenile nasopharyngeal angiofibroma extending through the nasopharynx and pterygopalatine fossa into the maxillary, sphenoid, and cavernous sinuses is demonstrated via an endoscopic, transnasal and frontotemporal, extended middle cranial fossa microsurgical approach. Management of a large pediatric tumor via narrow nasal passages, safe surgical resection around critical neurovascular structures, and complication avoidance is demonstrated.The video can be found here: https://youtu.be/1WqvsOnQCxs.

scholarly journals Nasopharyngeal Angiofibroma: A Forgotten Entity in Older Patients

2019 ◽  
Vol 12 ◽  
pp. 117954761984106
Author(s):  
Vanessa C Stubbs ◽  
Lauren E Miller ◽  
Arjun K Parasher ◽  
Jordan T Glicksman ◽  
Nithin D Adappa ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Older Patients ◽  
Elderly Population ◽  
Nasal Congestion ◽  
The Elderly ◽  
Middle Cranial Fossa ◽  
Nasopharyngeal Angiofibroma ◽  
Staging Systems ◽  
Local Destruction ◽  
Cranial Fossa

Introduction: Nasopharyngeal angiofibroma (NA) characteristically affects adolescent men. Although benign, these tumors can cause local destruction and surgical resection is warranted. Objective: We present a case of a 62-year-old man with nasal congestion and epistaxis, found to be a right NA on pathology. We also present a review of the available NA staging systems. Findings: In this case of NA, imaging revealed an aggressive, hypervascular mass in the nasal cavity with involvement of the middle cranial fossa and cavernous sinus. The patient underwent complete endoscopic surgical resection following vascular embolization. Conclusions: Although it is rare, NA should not be disregarded in the elderly population.

Surgical treatment of juvenile nasopharyngeal angiofibroma with intracranial extension

2009 ◽  
Vol 4 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Nevo Margalit ◽  
Oshri Wasserzug ◽  
Ari De-Row ◽  
Avraham Abergel ◽  
Dan M. Fliss ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adjuvant Therapy ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Nasopharyngeal Angiofibroma ◽  
Cranial Fossa ◽  
Midfacial Degloving

Object The purpose of this study was to describe the surgical treatment and outcomes of patients with intracranial extension of juvenile nasopharyngeal angiofibroma (JNA). Methods Twenty-one patients who underwent operations for JNAs between 1994 and 2008 were enrolled in the study. Seven patients (33%) had intracranial tumor extension. The middle cranial fossa and cavernous sinus were involved in 4 patients who underwent operations via the combined infratemporal fossa-midfacial degloving approach. The anterior skull base was involved in 3 patients who underwent the subcranialmidfacial degloving approach. Results Complete tumor removal was achieved in all patients. Postoperative complications included 1 case of soft-tissue infection. None of the patients had tumor recurrence after a mean follow-up of 42 months (range 29–85 months). No adjuvant therapy was required in any patient. Conclusions Combined approaches can be used effectively for treatment of JNAs with intracranial extension without the need for adjuvant therapy.

scholarly journals Radiation Therapy Improves Local Control in Juvenile Nasopharyngeal Angiofibroma following Disease Progression after Embolization and Surgical Resection: A Case Report

2021 ◽  
pp. 739-745
Author(s):  
Zane Blank ◽  
Richard Sleightholm ◽  
Beth Neilsen ◽  
Michael Baine ◽  
Chi Lin
Keyword(s):  
Radiation Therapy ◽  
Disease Progression ◽  
Surgical Resection ◽  
Local Control ◽  
Benign Neoplasm ◽  
Good Prognosis ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Adjuvant Radiation ◽  
Nasopharyngeal Angiofibroma ◽  
Presenting Symptoms

Juvenile nasopharyngeal angiofibroma (JNA) is a relatively uncommon, benign neoplasm of the nasopharynx that can be very difficult to diagnose early due to inconspicuous and seemingly harmless presenting symptoms. Early diagnosis and treatment of JNA are essential for a good prognosis. JNA typically responds well to radiation therapy (RT), but when it does not, the most appropriate next course of action has not been readily defined due to the limited occurrence and experience with this neoplasm. Herein, we describe a JNA patient, who continued to progress after surgery and 36 Gy of adjuvant radiation, but after an additional 14.4 Gy, he has remained in remission for over 2 years. An 11-year-old boy who presented with JNA underwent treatment with embolization and surgical resection. Unfortunately, the tumor progressed within 2 months of surgical intervention and he required RT for adequate local control. While undergoing RT, he again demonstrated signs of progression; so his radiation regimen was increased from 3,600 cGy in 20 fractions to 5,040 cGy in 28 fractions. Since completing RT, the tumor has continued to decrease in size, and the patient is stable and has been without signs of disease progression for over 24 months now. Thus, escalating the radiation regimen to 5,040 cGy may improve local control in rapidly progressive JNA.

Juvenile Nasopharyngeal Angiofibroma

1978 ◽  
Vol 87 (5) ◽  
pp. 630-632 ◽  
Author(s):  
Hugh F. Biller
Keyword(s):  
Surgical Resection ◽  
Clinical Examination ◽  
Adjunctive Therapy ◽  
Treatment Modality ◽  
Primary Treatment ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
X Rays ◽  
Arterial Ligation ◽  
Nasopharyngeal Angiofibroma ◽  
Primary Treatment Modality

The diagnosis of angiofibroma can be suspected in most cases by clinical examination, supplemented by routine x-rays and tomograms and is confirmed by angiography. Adjunctive therapy including embolization, estrogens, cryotherapy and arterial ligation is discussed. Surgical resection is the preferred treatment. Radiotherapy as the primary treatment modality is contra-indicated except in select cases.

scholarly journals Numerical variations and localization of foramen spinosum in 3D-CT images

2021 ◽  
Vol 15 (1) ◽  
pp. 59-63
Author(s):  
Yadigar Kastamoni ◽  
Ahmet Dursun ◽  
Veysel Atilla Ayyıldız ◽  
Kenan Öztürk
Keyword(s):  
Transverse Section ◽  
Middle Cranial Fossa ◽  
Ct Images ◽  
3D Ct ◽  
Foramen Ovale ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Cranial Fossa ◽  
Neurovascular Structures

Objectives: The structures passing through the foramen spinosum and its neurovascular relationships are of great importance for surgical approches directed to middle cranial fossa. The aim of the present study was to examine the number and location of the foramen spinosum (FS) in 3D-CT images. Methods: The study was retrospectively conducted on 3D-CT images of 177 adults. Firstly, the transverse section passing through the upper edge of the orbit, extending parallel to the Frankfurt plane was chosen. Then, the x and y-axes were determined on that transverse section. The coordinates, number, and location of the FS with respect to the foramen ovale (FO) were identified accordingly on x and y-axes. Results: While 1 FS was present in 90.96% of a total of 354 sides of 177 heads, there were 2 FS and 3 FS in 8.76% and 0.28% of the sides, respectively. The FS was located posterolaterally in 97.68%, posteriorly in 2.06%, and laterally in 0.26% with respect to the FO. In terms of FS coordinates, there was no statistically significant difference between gender and sides in the distance of the FS to the x-axis, but there was a statistically significant difference between gender and sides in the distance of the FS to the y-axis. Conclusion: Evaluation of the number of the FS and its location would help identifying and preserving neighbouring neurovascular structures during surgical interventions directed to the middle cranial fossa.

scholarly journals General craniometric characteristics of linear parameters of the middle cranial fossa of a mature person

2020 ◽  
Vol 26 (4) ◽  
pp. 55-61
Author(s):  
I.V. Chekanova ◽  
O.Yu. Vovk ◽  
V.B. Ikramov ◽  
S.O. Dubina
Keyword(s):  
Rapid Development ◽  
Middle Cranial Fossa ◽  
Bone Architecture ◽  
Morphological Data ◽  
Longitudinal Size ◽  
Length Width ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Neurovascular Structures ◽  
Mature Person

Given the rapid development of neurology, neurosurgery, otolaryngology and forensic medicine, there is a need for new, updated morphological data of internal base of the skull, in particular middle cranial fossa. This is due to the complex bone architecture of the middle cranial fossa and the location of important neurovascular structures in this area, which are important for surgeons not to damage during the operation. In this regard, it is necessary to detail the features of the structure, shape, position and size of the middle cranial fossa. The aim of the work is a detailed morphological and craniometric study of the linear parameters of the middle cranial fossa of a mature person depending on gender. The study was performed by studying 50 CT scans of the head and 50 bone preparations of the skulls of men and women of mature age. In our study, a detailed morphometry of longitudinal and latitudinal parameters at different levels of the middle cranial fossa, as well as determining its depth and area. Morphometry of linear parameters of the studied area of the skull showed the presence of a range of variability in length, width and depth depending on the sex of a mature person. The study showed an increase in the longitudinal size of the middle cranial fossa from the lateral to the medial; the transverse dimensions of the middle cranial fossa take on smaller values in its anterior parts and gradually increase to the posterior ones, which in our opinion is due to the characteristic shape of this part of the skull. The performed morphometry of longitudinal and latitudinal parameters, depth and area of the middle cranial fossa showed that these parameters are predominant in males in contrast to females, which is due to the slightly increased head size in this group of adult’s people. Depth of the middle cranial fossa has the smallest range of variability depending on sex. It is established that right-handed asymmetry is more often observed in mature people of both sexes. Rarely, left-sided asymmetry is determined due to an increase in the length of the lateral sections in mature men. The data obtained make it possible to expand knowledge about the structure of the middle cranial fossa and can serve as a basis for further research.

scholarly journals Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children

2015 ◽  
Vol 16 (5) ◽  
pp. 533-539 ◽  
Author(s):  
Tomomi Kimiwada ◽  
Toshiaki Hayashi ◽  
Ayumi Narisawa ◽  
Reizo Shirane ◽  
Teiji Tominaga
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Middle Cranial Fossa ◽  
Arachnoid Cysts ◽  
Shunt Placement ◽  
Younger Age ◽  
Abnormal Head ◽  
Cranial Fossa ◽  
Increased Icp ◽  
Cyst Fenestration

OBJECT Some pediatric patients with middle cranial fossa arachnoid cysts present with symptoms of increased intracranial pressure (ICP) and require shunt placement after a cyst fenestration. However, factors concerning increased ICP after fenestration followed by shunt placement have not been elucidated. This study evaluated factors that are associated with shunt placement following cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. METHODS Twenty-six pediatric patients with middle cranial fossa arachnoid cysts who were surgically treated at a single institution between 2004 and 2013 were retrospectively identified. The surgical indications for middle cranial fossa arachnoid cysts were as follows: 1) arachnoid cysts associated with symptoms such as headache and abnormally enlarging head circumference; 2) progressively expanding arachnoid cysts; and 3) large arachnoid cysts such as Galassi Type III. A cyst fenestration was performed as a first-line treatment, and shunt placement was required if symptoms associated with increased ICP were found following fenestration. The risk factors evaluated included age, sex, presenting symptoms, the presence of head enlargement, progressive cyst expansion, and subdural hematoma/hygroma. RESULTS Four patients (15.4%) required shunt placement after cyst fenestration. Younger age, abnormal head enlargement, and progressive cyst expansion before fenestration were significantly associated with the need for shunt placement following fenestration. Arachnoid cysts decreased in size in 22 patients (84.6%) after fenestration and/or shunt placement. The presence of symptoms was not associated with postoperative cyst size in this study. CONCLUSIONS In this study, younger age, abnormal head enlargement, and progressive cyst expansion were risk factors for shunt placement after cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. It is important to consider that cyst fenestration may not be effective because of a latent derangement of CSF circulation in patients with these risk factors.

Endoscopic approaches to the trigeminal nerve and clinical consideration for trigeminal schwannomas: a cadaveric study

2012 ◽  
Vol 117 (4) ◽  
pp. 690-696 ◽  
Author(s):  
Fuminari Komatsu ◽  
Mika Komatsu ◽  
Antonio Di Ieva ◽  
Manfred Tschabitscher
Keyword(s):  
Trigeminal Nerve ◽  
Infratemporal Fossa ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Minimal Invasiveness ◽  
Trigeminal Schwannoma ◽  
Minimally Invasive Surgical ◽  
Anterior Petrosectomy ◽  
Cranial Fossa ◽  
Neurovascular Structures

Object The course of the trigeminal nerve straddles multiple fossae and is known to be very complex. Comprehensive anatomical knowledge and skull base techniques are required for surgical management of trigeminal schwannomas. The aims of this study were to become familiar with the endoscopic anatomy of the trigeminal nerve and to develop a minimally invasive surgical strategy for the treatment of trigeminal schwannomas. Methods Ten fresh cadavers were studied using 5 endoscopic approaches with the aid of 4-mm 0° and 30° endoscopes to identify surgical landmarks associated with the trigeminal nerve. The endoscopic approaches included 3 transcranial keyhole approaches (the extradural supraorbital, extradural subtemporal, and retrosigmoid approaches), and 2 endonasal approaches (the transpterygoid and the transmaxillary transpterygoid approaches). Results The trajectories of the extradural supraorbital, transpterygoid, and extradural subtemporal approaches corresponded with the course of the first, second, and third divisions of the trigeminal nerve, respectively. The 3 approaches demonstrated each division in intra- and extracranial spaces, as well as the Meckel cave in the middle cranial fossa. The interdural space at the lateral wall of the cavernous sinus was exposed by the extradural supraorbital and subtemporal approaches. The extradural subtemporal approach with anterior petrosectomy and the retrosigmoid approach visualized the trigeminal sensory root and its neighboring neurovascular structures in the posterior cranial fossa. The transmaxillary transpterygoid approach revealed the course of the third division in the infratemporal fossa. Conclusions The 5 endoscopic approaches effectively followed the course of the trigeminal nerve with minimal invasiveness. These approaches could provide alternative options for the management of trigeminal schwannoma.

scholarly journals Multidisciplinary management of juvenile nasopharyngeal angiofibroma

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Walid Abouzeid ◽  
Ahmed Sultan ◽  
Mohamed Shadad
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Endoscopic Resection ◽  
Arterial Embolization ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Imaging Evaluation ◽  
Tissue Mass ◽  
Nasopharyngeal Angiofibroma ◽  
Male Patients

Abstract Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign, but the locally aggressive, vascular tumor that occurs almost exclusively in young men. Although this tumor accounts for only about 0.5% of head and neck tumors, it is by far the most common benign nasopharyngeal neoplasm. It is presented typically with epistaxis, obstructive symptoms, and chronic otomastoiditis. The examination of this tumor reveals pale reddish-blue mass. The tumor is seen on imaging as vividly augmenting soft-tissue mass centered on the sphenopalatine foramen. The treatment of choice is usually surgical resection; either open or endoscopic. Pre-operative embolization is usually done to help with hemostasis. We aim to address the efficiency and the safety of endovascular modality in JNA. Methods In the period between January 2012 to December 2017, 20 male patients with age ranging from 6 to 20 years were referred to the Endovascular Unit, at Departments of Neurosurgery in Sohag, Alexandria, and Tanta University Hospitals with JNF. Preoperative trans-arterial embolization was done, followed by endoscopic surgical resection by our ENT surgeons. All patients were subjected to clinical and radiological Imaging evaluation pre embolization, post embolization, and post endoscopic resection. All patients had clinical and radiological follow-ups for at least 1 year. Results 20 male patients with JNA underwent preoperative super-selective trans-arterial embolization. The average age at presentation was 13 years. All patients underwent successful embolization with total obliteration of vascular blush of the tumor in 15 patients, and near-total obliteration of blush in 5 patients. The dramatic effect of preoperative embolization was observed on limiting intraoperative blood loss (average 200 ml) and decreasing the time of surgery (average 2.5 h). There was no permanent morbidity or mortality related to either embolization or endoscopic resection in all patients. Conclusions Trans-arterial embolization is strongly recommended in patients with JNA, it offers a good assist to the surgeon, reduces blood loss, decreases the amount of transfusion, improves the degree of resection, reduces operative time, and decreases the incidence of recurrence.

scholarly journals A Case of Huge Nasopharyngeal Angiofibroma involving the Middle Cranial Fossa

1992 ◽  
Vol 3 (2) ◽  
pp. 375-384
Author(s):  
Chun Keun Park ◽  
Jae Wan Lee ◽  
Sang Hyun Kim ◽  
Seong Kook Park
Keyword(s):  
Middle Cranial Fossa ◽  
Nasopharyngeal Angiofibroma ◽  
Cranial Fossa
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