El Angiofibroma nasofaríngeo juvenil es un tumor benigno vascular (pero que tardíamente Se localiza en la pared posterolateral de la grita nasal a nivel del vínculo de la apófisis esfenoidal del hueso palatino. Esta localización conforma el. Nasal cavity, paranasal sinuses, nasopharynx – Nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibroma (JNA) is a rare and benign but locally in the nasopharynx and nasal cavity, leading to manifestations such as nasal.
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Although it is a rare neoplasm, juvenile nasopharyngeal angiofibroma JNA is associated with high rates of morbidity and mortality, with the potential for intracranial extension.
Surgical excision is the main treatment. The external approach has largely been replaced by the endoscopic approach in small lesions, and it can be used as a complement in more advanced cases. However, there is no consensus in the literature regarding the complications of surgical treatment of JNAs with intracranial extension. To assess the prevalence of complications in endoscopic or endoscopic-assisted surgical treatment of JNA angiofibrmoa minimal intracranial invasion.
This was a retrospective cohort study of all angifibroma with JNA with intracranial extension Radkowski grade IIIa treated with endoscopic, endoscopic-assisted, and external surgery from January of to May of Thirteen patients underwent surgery. Endoscopic surgery was performed in three patients, without postoperative complications; endoscopic-assisted surgery in three others, with two instances of complications, and external surgery in seven.
Operative treatment of nasopharyngeal angiofibroma with intracranial extension is one of the major challenges of ENT and neurosurgical practice.
The success angofibroma and low intra- and postoperative complication rates of endoscopic surgery suggest that this route has been gaining ground in the management of Radkowski grade IIIa JNAs.
Angiofibroma; Endoscopy; Video-assisted surgery; Recurrence; Intraoperative complications; Postoperative complications. Although it is a rare neoplasm, accounting for less than 0. Surgical excision is considered the treatment of choice for JNA, regardless of the presence of intracranial invasion.
For treatment of small lesions, external surgical approaches are gradually being replaced by endoscopic surgery, which can also be combined with conventional approaches in cases of more advanced disease. This was a retrospective cohort study. The sample comprised patients with a clinical and radiographic diagnosis of JNA with erosion of the skull base and minimal intracranial extension, meeting criteria for nxsal IIIa of the Radkowski classification.
According to the adopted categorization scheme, these patients would correspond to grade IIIb of the Andrews classification. All patients underwent preoperative embolization at a single interventional radiology service. For the purposes of this study, the presence of intraoperative or postoperative complications were evaluated and the rates of recurrence and reoperation were measured.
Pathology Outlines – Nasopharyngeal angiofibroma
Patients requiring craniotomy for neurosurgical access were excluded from the sample, since the findings associated with this route fell outside the scope of the present study. This study was approved by the local research ethics committee under protocol No. Thirteen patients met the criteria for inclusion and underwent surgical treatment. The demographic profile, surgical techniques used, immediate and delayed complications, and recurrence rate of the sample are listed in Table 1.
The chosen approach was fully endoscopic in three patients, fully external in seven, and combined endoscopic-assisted in three. Craniotomy was not performed in any of the patients. Mean patient age was The Radkowski and Andrews classifications are summarized in Tables 2 and 3 respectively. The patient underwent endoscopic- assisted surgery.
Nasopharyngeal angiofibroma – Wikipedia
Based on the Snyderman classification, 3 residual vascularity following preoperative embolization was present in all cases included the sample. Therefore, all cases corresponded to Snyderman grade IV Table 4. Massive bleeding was defined as that leading to hemodynamic instability and requiring packed red blood cell transfusion. In one patient, the procedure had to be halted due to persistent hypovolemic shock despite transfusion, and only partial resection of the tumor was achieved.
Immediate complications of surgery occurred in two patients. One developed oculomotor nerve palsy with CT findings indicative of cavernous sinus thrombosis, and the other sustained optic and oculomotor nerve injury manifesting as decreased visual activity and ptosis.
In both cases, a combined surgical approach had been employed. The patient with oculomotor nerve palsy had no improvement at the month follow-up. The condition of the second patient was also unchanged, with persistent palsy, at the month follow-up.
None of the patients who underwent fully endoscopic surgery developed any immediate or delayed complications. The disease-free period ranged from 10 to 36 months postoperatively. Detection of residual tumor on postoperative follow-up was the criterion for reoperation. The patient who received radiation therapy had an extensive residual lesion that was not amenable to surgical removal by any route.
Finally, watchful waiting was chosen as the most appropriate course of action for the remaining patient, due to an absence of symptoms or tumor growth during follow-up, which was probably due to the absence of residual vascularity.
Analysis of these 13 patients suggests that fully juvenll surgery is viable even in advanced cases of JNA. The endoscope has proved itself to be an important tool for visualizing the entire extent of these tumors, particularly in the region of the superior orbital fissure, cavernous sinus, and even in the pterygopalatine fossa, where the presence of residual lesions is not unusual after resection of tumors as extensive as those described in the present study.
Intraoperative endoscopy may thus render many osteotomies and bone resections unnecessary, which can decrease the risk of changes in juvejil growth. According to Onerci et al. Other essential requirements for the endoscopic approach include adequate surgeon experience, availability of proper instruments, performance of preoperative embolization, and the possibility of adding an open route if necessary.
This approach is consistent with the current literature, which recommends that a complete resection through the route associated with the least morbidity should be attempted whenever possible. In this study, immediate complications occurred in two patients who underwent surgery via endoscopic-guided external access. None of the three patients who underwent fully endoscopic surgery developed immediate or delayed complications.
Surgical treatment of JNA is fraught with technical anviofibroma, including the risk of intraoperative bleeding, difficulties in tumor dissection, and morbidity nassl with the involvement of certain nazal sites, as well as the risk of recurrence.
The occurrence of irreversible complications in the combined access group may be attributable angipfibroma the greater surgical difficulty of the affected cases, prompting the decision to use the endoscopic-guided access in the first place. Therefore, the irreversible lesions found in this group may have been the result of the technical challenges encountered during surgery.
Due to the benign nature of JNAs, the vast jjvenil of these tumors remain extradural even when there is intracranial extension, 9 and the surgical plane is situated between important structures such as the internal carotid artery and cavernous sinus. Even though JNAs are covered by nasopharyngeal mucosa, nazal the authors’ experience identification of the plane of dissection can be somewhat challenging, particularly when close to the cavernous sinus.
In this study, one patient developed a postoperative decline in visual acuity which remained at the month follow-up, most likely due to inadvertent optic nerve injury during the procedure.
The authors believe that this injury may have been secondary to the heat of electrocoagulation. Some authors maintain that endoscopic approaches should only be used when the tumor is angoofibroma to the nasal cavity, paranasal sinuses, pterygopalatine fossa, or infratemporal fossa. When a conventional approach is required for resection of lesions that extend beyond the juuvenil of endoscopic visualization, endoscopy should still be used as an adjunct to the external route.
The limitations of the present study should also be considered. As previously noted, this case series was restricted to non-neurosurgical routes; angiofibrroma who required craniotomy due to tumor extension Radkowski grade IIIb were excluded. However, in view of the findings of this study, fully endoscopic or endoscopic-guided access should be considered even for advanced-stage tumors with major intracranial extension.
Endoscopic treatment of lesions of the skull base is a branch of surgery that is currently undergoing rapid progress.
Use of neuronavigation techniques, intraoperative MRI, customized instruments, and ever-increasing surgical experience are all factors contributing to further advancements in this field, toward safer and more effective endoscopic approaches. The success rates and low intra- and postoperative complication rates of endoscopic surgery suggest that this route has been gaining ground in the management of Radkowski IIIa class JNAs.
Recent advances in the treatment of juvenile angiofibroma. Exclusively endoscopic surgery for juvenile nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg. A new endoscopic staging system for angiofibromas.
Arch Otolaryngol Head Neck Surg. Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol. Endoscopic versus traditional approaches for excision of juvenile nasopharyngeal angiofibroma.
The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. Douglas R, Wormald PJ. Endoscopic surgery for juvenile nasopharyngeal angiofibroma: Changes in staging and treatment.
Juvenile nasopharyngeal angiofibroma
European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma. Complications in the endoscopic and endoscopic-assisted treatment of juvenile nasopharyngeal angiofibroma with intracranial extension.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Services on Demand Journal. Introduction Although it is a rare neoplasm, accounting for less than 0. Materials juvneil methods This was a retrospective cohort study. Results Thirteen patients met the criteria for inclusion and underwent surgical treatment.
IIb Full occupation of the pterygomaxillary fossa, anterior displacement of the posterior wall of the maxillary antrum. Superior extension may occur, eroding orbital bones. IIc Extension through the pterygomaxillary juenil into the cheek and temporal fossa, or posterior to the pterygoid plates.
IIIa Erosion of the skull base with minimal intracranial extension. IIIb Erosion of the skull base with extensive intracranial extension with or without cavernous sinus invasion. Bone destruction jjvenil or limited to the sphenopalatine foramen II Invading the pterygopalatine fossa or the maxillary, ethmoid, or sphenoid sinus with bone destruction IIIa Invading the infratemporal fossa or orbital region without intracranial involvement IIIb Invading the infratemporal fossa or orbit with intracranial extradural parasellar involvement IVa Intracranial intradural tumor without infiltration of the cavernous sinus, pituitary fossa or optic chiasm IVb Intracranial intradural tumor with infiltration of the cavernous sinus, pituitary fossa or optic chiasm.
Discussion Analysis of these 13 patients suggests that fully endoscopic surgery is viable even in advanced cases of JNA. Angiofibromz Operative treatment of angiofibromz angiofibroma with intracranial extension is one of the major challenges of ENT and neurosurgical practice.
April 08, ; Accepted: Publicado por Elsevier Editora Ltda. Todos os direitos reservados. How to cite this article. Same as Ia, but with extension into one or more paranasal sinuses.