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Surgery for juvenile nasopharyngeal angiofibroma with lateral extension to the infratemporal fossa.
Auris Nasus Larynx 2014; 41(4):359-63AN

Abstract

OBJECTIVE

The study aimed to assess the usefulness of skull base surgery for large juvenile nasopharyngeal angiofibroma (JNA) with lateral extension to the infratemporal fossa.

MATERIALS AND METHODS

Eleven cases were enrolled for this study, and the mean age was 17.7 years old (range: 8-32). Six out of 11 cases underwent surgery as an initial treatment, and the other five underwent secondary surgery after initial surgery or radiotherapy in other institutions. The range of extension of tumor, feeding arteries, surgical approach, and treatment outcome were estimated.

RESULTS

All tumors originated from the sphenopalatine foramen. Based on the imaging study, there was extension to the cavernous sinus observed in eight cases, as well as to the middle cranial fossa (8), orbit (4), and anterior cranial fossa (1). These tumors were diagnosed as Andrews' Stage IVa (3) and IVb (8). However, infiltration into the cavernous sinus was observed in one case only during surgery. Ten tumors were separated carefully from the cavernous sinus or dura and were accurately diagnosed as Stage IIIb. In all cases, the main arterial feeders of the JNAs were branches of the external carotid artery, which were embolized prior to surgery. However, 10 cases were also fed by branches of the internal carotid artery (branches of the ophthalmic artery), in which these arteries could not be embolized. Coronal skin incision (1) and a facial dismasking flap (9) were used, and in one case, wide lateral skin incision with temporary incision of the facial nerve was applied. The orbito-zygomatic approach and its modification was applied to all the cases. Fronto-lateral craniotomy was applied in four cases and lateral craniotomy in seven cases. Total resection was achieved in 10 cases and subtotal resection in one case. No mortality was noted in this series. Temporal trismus was observed in all cases which subsided gradually. Cheek numbness and facial palsy were observed in three and two cases, respectively.

CONCLUSION

Coupled with craniotomy, tumor removal was successfully carried out in 11 patients with JNAs, which showed large lateral extension. Our surgical strategy is a safe and effective approach for the removal of JNAs with infratemporal fossa extension.

Authors+Show Affiliations

Department of Otolaryngology, Tokyo Medical and Dental University, Japan.Department of Otolaryngology, Tokyo Medical and Dental University, Japan. Electronic address: atsunoda@mac.com.Department of Otolaryngology, Tokyo Medical and Dental University, Japan.Department of Neurosurgery, Tokyo Medical and Dental University, Japan.Department of Neurosurgery, Tokyo Medical and Dental University, Japan.Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Japan.Department of Head & Neck Surgery, Tokyo Medical and Dental University, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24685728

Citation

Yamada, Masato, et al. "Surgery for Juvenile Nasopharyngeal Angiofibroma With Lateral Extension to the Infratemporal Fossa." Auris, Nasus, Larynx, vol. 41, no. 4, 2014, pp. 359-63.
Yamada M, Tsunoda A, Tokumaru T, et al. Surgery for juvenile nasopharyngeal angiofibroma with lateral extension to the infratemporal fossa. Auris Nasus Larynx. 2014;41(4):359-63.
Yamada, M., Tsunoda, A., Tokumaru, T., Aoyagi, M., Kawano, Y., Yano, T., & Kishimoto, S. (2014). Surgery for juvenile nasopharyngeal angiofibroma with lateral extension to the infratemporal fossa. Auris, Nasus, Larynx, 41(4), pp. 359-63. doi:10.1016/j.anl.2014.02.009.
Yamada M, et al. Surgery for Juvenile Nasopharyngeal Angiofibroma With Lateral Extension to the Infratemporal Fossa. Auris Nasus Larynx. 2014;41(4):359-63. PubMed PMID: 24685728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgery for juvenile nasopharyngeal angiofibroma with lateral extension to the infratemporal fossa. AU - Yamada,Masato, AU - Tsunoda,Atsunobu, AU - Tokumaru,Takao, AU - Aoyagi,Masaru, AU - Kawano,Yoshihisa, AU - Yano,Tomoyuki, AU - Kishimoto,Seiji, Y1 - 2014/03/28/ PY - 2013/05/20/received PY - 2014/02/11/revised PY - 2014/02/27/accepted PY - 2014/4/2/entrez PY - 2014/4/2/pubmed PY - 2014/12/31/medline KW - Craniotomy KW - Infratemporal fossa KW - Juvenile nasopharyngeal angiofibroma KW - Orbito-zygomatic approach KW - Sphenopalatine foramen SP - 359 EP - 63 JF - Auris, nasus, larynx JO - Auris Nasus Larynx VL - 41 IS - 4 N2 - OBJECTIVE: The study aimed to assess the usefulness of skull base surgery for large juvenile nasopharyngeal angiofibroma (JNA) with lateral extension to the infratemporal fossa. MATERIALS AND METHODS: Eleven cases were enrolled for this study, and the mean age was 17.7 years old (range: 8-32). Six out of 11 cases underwent surgery as an initial treatment, and the other five underwent secondary surgery after initial surgery or radiotherapy in other institutions. The range of extension of tumor, feeding arteries, surgical approach, and treatment outcome were estimated. RESULTS: All tumors originated from the sphenopalatine foramen. Based on the imaging study, there was extension to the cavernous sinus observed in eight cases, as well as to the middle cranial fossa (8), orbit (4), and anterior cranial fossa (1). These tumors were diagnosed as Andrews' Stage IVa (3) and IVb (8). However, infiltration into the cavernous sinus was observed in one case only during surgery. Ten tumors were separated carefully from the cavernous sinus or dura and were accurately diagnosed as Stage IIIb. In all cases, the main arterial feeders of the JNAs were branches of the external carotid artery, which were embolized prior to surgery. However, 10 cases were also fed by branches of the internal carotid artery (branches of the ophthalmic artery), in which these arteries could not be embolized. Coronal skin incision (1) and a facial dismasking flap (9) were used, and in one case, wide lateral skin incision with temporary incision of the facial nerve was applied. The orbito-zygomatic approach and its modification was applied to all the cases. Fronto-lateral craniotomy was applied in four cases and lateral craniotomy in seven cases. Total resection was achieved in 10 cases and subtotal resection in one case. No mortality was noted in this series. Temporal trismus was observed in all cases which subsided gradually. Cheek numbness and facial palsy were observed in three and two cases, respectively. CONCLUSION: Coupled with craniotomy, tumor removal was successfully carried out in 11 patients with JNAs, which showed large lateral extension. Our surgical strategy is a safe and effective approach for the removal of JNAs with infratemporal fossa extension. SN - 1879-1476 UR - https://www.unboundmedicine.com/medline/citation/24685728/Surgery_for_juvenile_nasopharyngeal_angiofibroma_with_lateral_extension_to_the_infratemporal_fossa_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0385-8146(14)00037-6 DB - PRIME DP - Unbound Medicine ER -