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Eugine R, Ps S, Bhardwaj A, Sahu MP. Challenges and innovations in managing a complex giant bilateral juvenile nasopharyngeal angiofibroma with intracranial extension. BMJ Case Rep 2024; 17:e258641. [PMID: 39174044 DOI: 10.1136/bcr-2023-258641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular, benign and locally aggressive tumour that predominantly affects adolescent males. Recognised for its persistence and propensity to recur, patients usually present with gradual development of symptoms such as epistaxis and nasal obstruction over several months to years. Diagnosis typically combines clinical assessments and radiographic studies, often involving preoperative angiography to identify feeder vessels and facilitate embolisation, reducing intraoperative bleeding during surgical interventions. A comprehensive approach to treatment, considering both tumour characteristics and patient well-being, is crucial, particularly when dealing with cases involving intracranial extension. Surgical excision remains the primary treatment for angiofibroma, though radiotherapy is considered for cases with intracranial extension. This case report outlines a case involving a young man in his 20s with a large bilateral JNA extending into the intracranial area. The patient underwent preoperative embolisation followed by surgical resection using a nasofrontomaxillary swing approach with a bifrontal craniotomy window. This alternative approach provided enhanced exposure to address the involvement of the infratemporal fossa, anterior and middle skull base. Postoperatively, residual intracranial tumour was managed with radiation therapy. Over a 2-year follow-up, the patient remains asymptomatic, with a minor postradiation reduction in the intracranial component's size.
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Affiliation(s)
- Reshma Eugine
- Otorhinolaryngology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, India
| | - Suji Ps
- ENT, All India Institute of Medical Sciences-Rishikesh, Rishikesh, India
| | - Abhishek Bhardwaj
- Otorhinolaryngology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, India
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Kasai S, Akahane K, Tamai M, Goi K, Ishii H, Sakurai D, Inukai T. Dose-dependent tumor regression during sirolimus therapy in an advanced juvenile nasopharyngeal angiofibroma case. Pediatr Int 2024; 66:e15807. [PMID: 39312387 DOI: 10.1111/ped.15807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/17/2024] [Accepted: 05/29/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Shin Kasai
- Department of Pediatrics, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Koshi Akahane
- Department of Pediatrics, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Minori Tamai
- Department of Pediatrics, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kumiko Goi
- Department of Pediatrics, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroki Ishii
- Department of Otorhinolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Daiju Sakurai
- Department of Otorhinolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Takeshi Inukai
- Department of Pediatrics, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
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3
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Hoeltgen L, Tessonnier T, Meixner E, Hoegen P, Kim JY, Deng M, Seidensaal K, Held T, Herfarth K, Debus J, Harrabi S. Proton Therapy for Advanced Juvenile Nasopharyngeal Angiofibroma. Cancers (Basel) 2023; 15:5022. [PMID: 37894389 PMCID: PMC10605854 DOI: 10.3390/cancers15205022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE To provide the first report on proton radiotherapy (PRT) in the management of advanced nasopharyngeal angiofibroma (JNA) and evaluate potential benefits compared to conformal photon therapy (XRT). METHODS We retrospectively reviewed 10 consecutive patients undergoing PRT for advanced JNA in a definitive or postoperative setting with a relative biological effectiveness weighted dose of 45 Gy in 25 fractions between 2012 and 2022 at the Heidelberg Ion Beam Therapy Center. Furthermore, dosimetric comparisons and risk estimations for short- and long-term radiation-induced complications between PRT plans and helical XRT plans were conducted. RESULTS PRT was well tolerated, with only low-grade acute toxicities (CTCAE I-II) being reported. The local control rate was 100% after a median follow-up of 27.0 (interquartile range 13.3-58.0) months. PRT resulted in considerable tumor shrinkage, leading to complete remission in five patients and bearing the potential to provide partial or complete symptom relief. Favorable dosimetric outcomes in critical brain substructures by the use of PRT translated into reduced estimated risks for neurocognitive impairment and radiation-induced CNS malignancies compared to XRT. CONCLUSIONS PRT is an effective treatment option for advanced JNA with minimal acute morbidity and the potential for reduced radiation-induced long-term complications.
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Affiliation(s)
- Line Hoeltgen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ji-Young Kim
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Maximilian Deng
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, 69120 Heidelberg, Germany
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
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Capodiferro S, Limongelli L, D’Agostino S, Tempesta A, Dolci M, Maiorano E, Favia G. Diode Laser Management of Primary Extranasopharyngeal Angiofibroma Presenting as Maxillary Epulis: Report of a Case and Literature Review. Healthcare (Basel) 2021; 9:healthcare9010033. [PMID: 33401498 PMCID: PMC7824373 DOI: 10.3390/healthcare9010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022] Open
Abstract
Juvenile nasopharyngeal angiofibroma is a rare vascular neoplasm, mostly occurring in adolescent males, and representing 0.05% of all head and neck tumors. Nevertheless, it is usually recognized as the most common benign mesenchymal neoplasm of the nasopharynx. Usually, it originates from the posterolateral wall of the nasopharynx and, although histologically benign, classically shows a locally aggressive behavior with bone destruction as well as spreading through natural foramina and/or fissures to the nasopharynx, nasal and paranasal cavities, spheno-palatine foramen, infratemporal fossa and, very rarely, to the cranial cavity. Extranasopharyngeal angiofibroma is considered a distinct entity due to older age at presentation, different localizations (outside the nasopharyngeal pterygopalatine fossa) and attenuated clinical course. Extranasopharyngeal angiofibroma has been sporadically described in the oral cavity. We report a case of extranasopharyngeal angiofibroma with primary and exclusive involvement of the adherent gingiva of the anterior maxilla, managed by preoperative diode laser trans-mucosal photocoagulation and subsequent surgical removal. The current literature on primary extranasopharyngeal angiofibroma is also reviewed.
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Affiliation(s)
- Saverio Capodiferro
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (S.C.); (L.L.); (A.T.); (G.F.)
| | - Luisa Limongelli
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (S.C.); (L.L.); (A.T.); (G.F.)
| | - Silvia D’Agostino
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti Pescara, 66100 Chieti, Italy;
- Correspondence: ; Tel.: +39-3930246351
| | - Angela Tempesta
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (S.C.); (L.L.); (A.T.); (G.F.)
| | - Marco Dolci
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti Pescara, 66100 Chieti, Italy;
| | - Eugenio Maiorano
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (S.C.); (L.L.); (A.T.); (G.F.)
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Abboud FZ, Youssoufi MA, Zoukal S, Bouhafa T, Hassouni K. Recurrent pterygo-palatal angiofibroma with intracranial extension: case report. Pan Afr Med J 2020; 36:128. [PMID: 32849983 PMCID: PMC7422746 DOI: 10.11604/pamj.2020.36.128.22435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
We report the case of a patient with recurrent pterygo-palatal angiofibroma and its treatment. A 21-year-old male patient had a long history of recurrent epistaxis with progressive nasal obstruction. He was diagnosed with an angiofibroma centered in the right pterygo-palatine fossa. Initially, he underwent surgical excision with removal of the entire tumor. The evolution was clinically good with no signs of recurrence on the cervico-facial scan of control (CT). Nine months after, he presented a reappearance of epistaxis. A cervico-facial MRI was performed and showed a recurrence of the tumor process, which this time was considered inextirpable, hence the decision to opt for radiotherapy with intensity modulated radiation therapy (IMRT). He has improved clinically with a clear reduction in tumor mass on CT scan. This technique represents an interesting alternative to overcome anatomical complexity of the region, cover the tumor and preserve the organs at risk.
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Affiliation(s)
- Fatima Zahra Abboud
- Department of Radiation Oncology, University Hospital Hassan II, Fez, Morocco
| | - Moulay Ali Youssoufi
- Medical Physics Unit, Oncology Hospital, University Hospital Hassan II, Fez, Morocco
| | - Sofia Zoukal
- Epidemiology Laboratory of the Faculty of Medicine and Pharmacy of Casablanca, Casablanca, Morocco
| | - Touria Bouhafa
- Department of Radiation Oncology, University Hospital Hassan II, Fez, Morocco
| | - Khalid Hassouni
- Department of Radiation Oncology, University Hospital Hassan II, Fez, Morocco
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Yu J, Choi JS, Giannoni C, Patel AJ, Gallagher KK. Juvenile Nasopharyngeal Angiofibroma Outcomes and Cost: Analysis of the Kids’ Inpatient Database. Ann Otol Rhinol Laryngol 2019; 129:498-504. [DOI: 10.1177/0003489419896597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: To report trends in Juvenile Nasopharyngeal Angiofibroma (JNA) hospitalizations and identify key factors affecting treatment outcomes and cost of care in JNA patients. Methods: The Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database was queried for all cases of JNA between the years of 1997 and 2016. Key factors extracted were patient demographics, geographic region, hospital size, teaching status, elective admissions, and number of diagnoses and procedures performed during the hospitalization. These elements were correlated to length of stay (LOS) and cost-per-day (CPD) using a multiple linear regression (MLR). Regional variation in JNA diagnosis and changes in LOS and CPD trends over time were also analyzed. Results: A total of 614 JNA patients were hospitalized in this time period, with a majority of patients identifying as male (98%) and Caucasian/White (55%). The average LOS has decreased by 0.14 day per year since 1997 ( P = .0034) whereas the CPD has steadily increased by $2 380 per year ( P < .001). MLR analysis revealed that while holding all other factors constant, patients who stayed at teaching hospitals had an increased LOS of 1.7 days ( P = .026), but paid $11 961 less per day ( P = .05). Regional variation in CPD was found in the Northeast region, where hospitalizations were more expensive by $9 801 per day compared to the South ( P = .017). Conclusion: These results indicate hospital characteristics, such as teaching status and geographic region, may predict differences in JNA outcomes and cost. Healthcare providers should be cognizant of these variations to ensure optimal patient outcomes and expenditures.
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Affiliation(s)
- Justin Yu
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan S. Choi
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Carla Giannoni
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Akash J. Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - K. Kelly Gallagher
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
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Sousa S, Patrão F, Pereira G, Monteiro E. Juvenile nasopharyngeal angiofibroma: A retrospective study of 27 cases in the ENT department of IPO‐PORTO. Clin Otolaryngol 2019; 44:456-460. [DOI: 10.1111/coa.13309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/18/2018] [Accepted: 02/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Sofia Sousa
- Department of Otorhinolaryngology Centro Hospitalar Tondela‐Viseu Viseu Portugal
| | - Francisco Patrão
- Department of Otorhinolaryngology Centro Hospitalar Tondela‐Viseu Viseu Portugal
| | - Gabriel Pereira
- Department of Otorhinolaryngology Centro Hospitalar Tondela‐Viseu Viseu Portugal
| | - Eurico Monteiro
- Department of Otorhinolaryngology‐Head and Neck Surgery Instituto Português de Oncologia do Porto Porto Portugal
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8
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Tawfik KO, Harmon JJ, Walters Z, Samy R, de Alarcon A, Stevens SM, Abruzzo T. Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma. Ann Otol Rhinol Laryngol 2018; 127:344-348. [DOI: 10.1177/0003489418761456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. Methods: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. Results: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Conclusions: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.
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Affiliation(s)
- Kareem O. Tawfik
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey J. Harmon
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zoe Walters
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ravi Samy
- Division of Otology/Neurotology, Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine/Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Center for Pediatric Voice Disorders, Division of Pediatric Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine/Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shawn M. Stevens
- Arizona Otolaryngology Consultants and Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Todd Abruzzo
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Bradoo R, Joshi A, Shah K, Patel T, Lohiya T. The Four-Port Bradoo Technique: An Alternative to the Modified Endoscopic Denker's Approach for Giant JNA. Indian J Otolaryngol Head Neck Surg 2017; 69:277-281. [PMID: 28929055 DOI: 10.1007/s12070-017-1150-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/16/2017] [Indexed: 11/28/2022] Open
Abstract
The aim of this study is to emphasise the importance of preserving the anterior facial skeleton in angiofibroma surgery and to introduce a new approach by which tumors with far lateral extensions can be operated upon successfully without disruption of the anterior facial skeleton. This is a prospective study conducted at a tertiary referral academic centre. Two patients with extensive juvenile nasopharyngeal angiofibroma with far lateral extensions were recruited and they underwent surgery between July and August 2016. Both patients were not embolised prior to surgery. Complete tumor removal was achieved in both cases without any evidence of recurrence of disease. The facial contour was well maintained. They are under regular follow-up at our centre, having completed their third 3 monthly follow-up. The main outcome measures are preservation of the anterior facial skeleton and complete tumor removal. The Four-Port Bradoo Technique allows for maximum access to the angiofibroma whilst maintaining the anterior facial skeleton, thus ensuring complete removal with minimal morbidity to the patient.
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Affiliation(s)
- Renuka Bradoo
- Department of ENT and Head-Neck Surgery, Lokmanya Tilak Municipal Medical College and General Hospital (Sion Hospital), Room No 441, 4th Floor, College Building, Sion, Mumbai, 400022 India
| | - Anagha Joshi
- Department of ENT and Head-Neck Surgery, Lokmanya Tilak Municipal Medical College and General Hospital (Sion Hospital), Room No 441, 4th Floor, College Building, Sion, Mumbai, 400022 India
| | - Kshtij Shah
- Department of ENT and Head-Neck Surgery, Lokmanya Tilak Municipal Medical College and General Hospital (Sion Hospital), Room No 441, 4th Floor, College Building, Sion, Mumbai, 400022 India
| | - Tejal Patel
- Department of ENT and Head-Neck Surgery, Lokmanya Tilak Municipal Medical College and General Hospital (Sion Hospital), Room No 441, 4th Floor, College Building, Sion, Mumbai, 400022 India
| | - Tanvi Lohiya
- Department of ENT and Head-Neck Surgery, Lokmanya Tilak Municipal Medical College and General Hospital (Sion Hospital), Room No 441, 4th Floor, College Building, Sion, Mumbai, 400022 India
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Alshaikh NA, Eleftheriadou A. Juvenile nasopharyngeal angiofibroma staging: An overview. EAR, NOSE & THROAT JOURNAL 2016; 94:E12-22. [PMID: 26053985 DOI: 10.1177/014556131509400615] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.
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Affiliation(s)
- Nada Ali Alshaikh
- Department of Otolaryngology, Dammam Medical Complex, PO Box 2471, Dammam 31451, Saudi Arabia.
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12
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Gronkiewicz Z, Kukwa W, Krolicki L, Cyran-Chlebicka A, Pawlak D, Stankiewicz C, Krzeski A, Górnicka B, Wolosz D, Kunikowska J. 68Ga-DOTATATE PET in juvenile angiofibroma. Future Oncol 2016; 12:1483-91. [DOI: 10.2217/fon-2015-0074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: As somatostatin receptors (SSTRs) may be overexpressed in rapidly growing vessels, the aim of this study was the analysis of in vivo and in vitro SSTR2A expression in juvenile angiofibroma (JA). Material & methods: A group of six male adolescents with a diagnosis of primary, recurrent/residual JA was enrolled in the study. All patients underwent 68Ga-DOTATATE PET/computed tomography (CT) followed by immunohistochemical staining for SSTR expression. Results: 68Ga-DOTATATE PET/CT showed accumulation in areas matching the pathologic tissue in the nasopharynx of all patients studied with SUVmax of 5.1 ± 0.9 (ranging from 3.6 to 6.4). In all cases, the immunohistochemical examination showed a presence of SSTR2A with a high staining index. Conclusion: In vitro SSTR2A cytoplasm expression was found to be high in all tumor specimens. However, the uptake of 68Ga-DOTATATE was weak in the PET/CT studies. We postulate that the intracellular localization of the SSTR2A in JA may cause this discrepancy.
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Affiliation(s)
- Zuzanna Gronkiewicz
- Department of Otorhinolaryngology, Faculty of Medicine & Dentistry, Medical University of Warsaw, 19/25 Stepinska Street, 00-739 Warsaw, Poland
| | - Wojciech Kukwa
- Department of Otorhinolaryngology, Faculty of Medicine & Dentistry, Medical University of Warsaw, 19/25 Stepinska Street, 00-739 Warsaw, Poland
| | - Leszek Krolicki
- Nuclear Medicine Department, Medical University of Warsaw, 1a Banacha Street, 02-097 Warsaw, Poland
| | - Agata Cyran-Chlebicka
- Department of Pathology, Medical University of Warsaw, 7 Pawinskiego Street, 02-106 Warsaw, Poland
| | - Dariusz Pawlak
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, Otwock, Poland
| | - Czeslaw Stankiewicz
- Department of Otolaryngology, Medical University of Gdansk, 7 Debinki Street, 80-952 Gdansk, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Faculty of Medicine & Dentistry, Medical University of Warsaw, 19/25 Stepinska Street, 00-739 Warsaw, Poland
| | - Barbara Górnicka
- Department of Pathology, Medical University of Warsaw, 7 Pawinskiego Street, 02-106 Warsaw, Poland
| | - Dominika Wolosz
- Department of Pathology, Medical University of Warsaw, 7 Pawinskiego Street, 02-106 Warsaw, Poland
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, 1a Banacha Street, 02-097 Warsaw, Poland
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Resection of a juvenile nasoangiofibroma by Le Fort I osteotomy: Experience with 40 cases. J Craniomaxillofac Surg 2015; 43:1501-4. [PMID: 26265049 DOI: 10.1016/j.jcms.2015.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/31/2015] [Accepted: 06/17/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study was to determine the rate of success and complications of juvenile nasoangiofibroma resection by Le Fort I osteotomy. MATERIAL AND METHODS Data were obtained from the medical records of 40 patients with a diagnosis of juvenile nasoangiofibroma confirmed by anatomopathological examination. All tumors were resected by Le Fort I osteotomy between 1983 and 2010. The data obtained were gender, age, symptoms, sites of invasion, preoperative embolization, routes of surgical access, duration of surgery, complications, need for transfusion, relapses, and follow-up time. RESULTS All patients were male, ranging in age from 7 to 27 years. The most common symptom was nasal obstruction, and central nervous system (CNS) invasion was present in 27.5% of cases. Craniotomy was associated with Le Fort I osteotomy in only one case. The mean duration of surgery was 216 min. Complications occurred in 15% of cases, with intraoperative bleeding being the most frequent one. Relapses occurred in 5% of cases. The mean follow-up was 48.8 months. CONCLUSION Exclusively surgical treatment by Le Fort I access proved to be a safe and effective method for the treatment of nasoangiofibromas, permitting the removal of tumors even in patients with extension to the CNS, with a low rate of complications and relapses.
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The combined subtemporal-transfacial approach for the resection of juvenile nasopharyngeal angiofibromas with intracranial extension. Otol Neurotol 2014; 36:151-5. [PMID: 25036780 DOI: 10.1097/mao.0000000000000498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stage IVb juvenile nasopharyngeal angiofibromas (JNAs) are frequently regarded as unresectable because of their intracranial extension and cavernous sinus invasion. Although radiation has been described to control these tumors, it can leave the adolescent with long-lasting sequelae. Herein, we describe an alternative treatment strategy based on a combined subtemporal-transfacial surgical approach that permits the successful management of advanced stage JNAs by divorcing the intracranial vascular supply to these massive lesions. PATIENTS Four male patients were identified with Andrew's Stage IVB JNAs. INTERVENTION All patients were treated by surgical resection using a combined subtemporal-transfacial surgical approach. MAIN OUTCOME MEASURES Parameters assessed included tumor extent, number and types of surgical procedures, extent of resections, complications, and recurrence rate. RESULTS Near-total tumor resections were achieved in all patients. No cerebrospinal fluid leak or cranial neuropathies were noted. All but one patient had local recurrences, and these could be managed with repetitive endoscopic debridement. No patient required adjuvant radiation treatment to control advanced disease. CONCLUSIONS With the use of modern skull base surgical techniques, coordinated interdisciplinary care, and safe, near-total removal of the tumor mass, adolescent males with advanced JNAs may be spared the long-term morbidities associated with using radiation to treat these benign but aggressive lesions.
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Szewczyk-Bieda MJ, White RD, Budak MJ, Ananthakrishnan G, Brunton JN, Sudarshan TA. A whiff of trouble: tumours of the nasal cavity and their mimics. Clin Radiol 2014; 69:519-28. [PMID: 24525221 DOI: 10.1016/j.crad.2013.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 12/28/2022]
Abstract
A range of disease entities can affect the nasal cavity, often presenting with variable and non-specific symptoms. There is considerable overlap between the clinical and radiological features of neoplastic and non-neoplastic entities. The nasal cavity is often included in routine imaging of the brain, middle ear, skull base, and paranasal sinuses and should be included as a critical review area. The definitive diagnosis is in most cases confirmed by histopathological analysis. However, this review highlights the role of imaging in identifying nasal cavity disease, eliciting features of aggressive or indolent behaviour, and helping to narrow the differential diagnosis, thus facilitating a systematic approach when reviewing the nasal cavity.
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Affiliation(s)
- M J Szewczyk-Bieda
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK.
| | - R D White
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - M J Budak
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - G Ananthakrishnan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, Manchester Royal Infirmary Hospital, Manchester, UK
| | - J N Brunton
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - T A Sudarshan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
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Leong SC. A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope 2013; 123:1125-31. [DOI: 10.1002/lary.23760] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/14/2012] [Accepted: 09/07/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Samuel C. Leong
- Department of Otorhinolaryngology-Head and Neck Surgery, Skull Base Unit; University Hospital Aintree; Liverpool; United Kingdom
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Succo G, Gisolo M, Crosetti E, Bergui M, Danesi G. Spontaneous ICA rupture: a severe late complication after giant nasopharyngeal angiofibroma resection. Int J Pediatr Otorhinolaryngol 2013; 77:581-4. [PMID: 23312351 DOI: 10.1016/j.ijporl.2012.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/16/2012] [Accepted: 12/18/2012] [Indexed: 11/15/2022]
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular tumor occurring in young males. Surgery for giant JNA is a complex procedure, with a high risk of major complications. We report a rare case of massive epistaxis in a 15-year-old boy resulting from spontaneous rupture of the intracavernous tract of the internal carotid artery 20 days after resection of a giant JNA by midface degloving. The event was managed by an emergency arteriography with coils selectively deployed to occlude the vessel and to stop hemorrhage. This treatment has been shown to be effective in producing immediate hemostasis and stable long-term occlusion.
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Affiliation(s)
- G Succo
- ENT Department, S Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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Oliveira JAA, Tavares MG, Aguiar CV, Azevedo JFD, Sousa JRF, Almeida PCD, Gomes EF. Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma. Braz J Otorhinolaryngol 2012; 78:75-80. [PMID: 22392242 PMCID: PMC9444542 DOI: 10.1590/s1808-86942012000100012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 11/24/2011] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Juvenile nasopharyngeal angiofibroma is a rare benign vascular tumor of the nasopharynx. Although the treatment of choice is surgery, there is no consensus on what is the best approach. AIM To compare surgical time and intraoperative transfusion requirements in patients undergoing endoscopic surgery versus open / combined and relate the need for transfusion during surgery with the time between embolization and surgery. MATERIAL AND METHODS Study descriptive, analytical, retrospective study with a quantitative approach developed in the Otorhinolaryngology department of a teaching hospital. Analyzed 37 patients with angiofibroma undergoing surgical treatment. Data obtained from medical records. Analyzed with tests of the Fisher-Freeman-Halton and Games-Howell. Was considered significant if p <0.05. STUDY DESIGN Historical cohort study with cross-sectional. RESULTS The endoscopic approach had a shorter operative time (p <0.0001). There is less need for transfusion during surgery when the embolization was performed on the fourth day. CONCLUSION This suggests that the period ahead would be ideal to perform the process of embolization and endoscopic surgery by demanding less time would be associated with a lower morbidity. This study, however, failed to show which group of patients according to tumor stage would benefit from specific technical.
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Blount A, Riley KO, Woodworth BA. Juvenile nasopharyngeal angiofibroma. Otolaryngol Clin North Am 2012; 44:989-1004, ix. [PMID: 21819885 DOI: 10.1016/j.otc.2011.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile nasopharyngeal angiofibromas (JNAs) are rare, benign, highly vascular, locally aggressive tumors that primarily affect male adolescents. Historical treatment of these neoplasms has been primarily surgical. In the past decade, endoscopic resection of JNAs has become a viable and promising surgical treatment option. Endoscopic resection has many advantages over traditional open techniques, including better cosmesis, decreased blood loss, shortened hospital stays, and equivalent or improved recurrence rates. Emerging endoscopic technology continues to push the boundaries of resection of skull base tumors and will no doubt become the surgical treatment of choice for most JNAs in the near future.
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Affiliation(s)
- Angela Blount
- Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, 563 Boshell Building, 1530 3rd Avenue South, Birmingham, AL 35294-0012, USA
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Balcerzak J, Gotlib T, Hamera M, Osuch-Wójcikiewicz E, Niemczyk K. [Angifibroma juvenile--evolution of surgical management]. Otolaryngol Pol 2011; 65:12-6. [PMID: 22000245 DOI: 10.1016/s0030-6657(11)70703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 08/08/2011] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Juvenile Angiofibroma has been challenged generations of surgeons. The problem is, not only in specific clinical features of the tumour, but also in difficult surgical approach to anatomical area in which it is located. THE AIM OF THE STUDY was to analyze development of surgical techniques in treatment of juvenile angiofibroma and potential conditions which influence on therapy results. MATERIAL AND METHOD The retrospective study that analyzes 47 juvenile angiofibroma cases, which were treated in the Otorhinolaryngology Department of Warsaw Medical University in years 1980–2010. RESULTS The five surgical approaches were used in the group of patients, filled in this study. The use of midfacial degloving has become increasingly popular, replacing lateral rhinotomy and transpalatal approach, which were commonly used in early nineties of the last century. The infratemporal approach was used in one case of disease with parapharyngeal and infratemporal extension. One of the recent patients was treated, first time in history of the Department, using endoscopic approach. The routine protocol of treatment includes preoperative CT and MRI and angiography with embolization of the main tumour vessels. The gradual, but consequent improvement in therapy results is revealed as reduction of recurrence from 35% to 20%. CONCLUSIONS In therapy of juvenile angiofibroma become popular surgical techniques, which are not connected with visible scars and which reduce tissue trauma in operated area. Besides mastering surgical skills, the independent condition, which improves therapy results, is using modern diagnostic and therapeutic procedures. They contribute to better assessment of tumour location and extension, and reduction of intraoperative blood loss.
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Karmon Y, Siddiqui AH, Hopkins LN. Juvenile Nasopharyngeal Angiofibroma—How Should We Embolize, If At All? World Neurosurg 2011. [DOI: 10.1016/j.wneu.2011.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fyrmpas G, Konstantinidis I, Constantinidis J. Endoscopic treatment of juvenile nasopharyngeal angiofibromas: our experience and review of the literature. Eur Arch Otorhinolaryngol 2011; 269:523-9. [DOI: 10.1007/s00405-011-1708-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 07/04/2011] [Indexed: 11/25/2022]
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Eloy P, Bachy V, Grulois V, Bertrand B. Pyocele of the lachrymal sac: A late and unusual complication after surgery for a juvenile nasopharyngeal angiofibroma. Clin Ophthalmol 2011; 2:211-5. [PMID: 19668408 PMCID: PMC2698692 DOI: 10.2147/opth.s2280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
JNA (Juvenile nasopharyngeal angiofibroma) is a benign but highly vascular and aggressive tumor that takes its origin in the basisphenoid region close to the sphenopalatine foramen. It occurs invariably in male teenagers. Surgery is the treatment of choice. In the past, external transfacial approaches were recommended. Nowadays endonasal endoscopic approach is performed by experienced teams even for extended tumor. The authors report a case of a pyocele of the lachrymal sac occurring 60 years after a transantral surgery for a JNA. The patient was then successfully operated with an endonasal endoscopic dacryocystorhinostomy using a powered instrumentation and a navigation system. This case confirms the necessity of a long follow-up for all the patients who had a transantral surgery with resection of the medial wall of the maxillary sinus and dissection of the nasolacrymal duct.
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Affiliation(s)
- Philippe Eloy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
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Cherekaev VA, Golbin DA, Kapitanov DN, Roginsky VV, Yakovlev SB, Arustamian SR. Advanced craniofacial juvenile nasopharyngeal angiofibroma. Description of surgical series, case report, and review of literature. Acta Neurochir (Wien) 2011; 153:499-508. [PMID: 21274578 DOI: 10.1007/s00701-010-0922-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor occurring almost exclusively in adolescent and young adult males. The tumor is characterized by slow progression, aggressive growth, high vascularization, and increased rate of persistence and recurrence. The aim of this study was to describe a case of giant JNA from our practice and discuss the controversies of surgical treatment of advanced JNA. MATERIAL AND METHODS A series of 29 consecutive male patients with JNA Fisch grade III and IV was surgically treated in Burdenko Neurosurgical Institute from 2000 until 2008. In the vast majority of cases, endovascular embolization and surgical removal via orbitozygomatic approach were applied. RESULTS Gross total resection was achieved in 24 cases (83%). Complications were encountered in eight cases. No mortality was observed. In three patients, the diseases recurred. An illustrative case is described. CONCLUSION Surgical treatment is the basic tactics in management of extensive JNA including endovascular embolization and resection of the tumor. We recommend using orbitozygomatic approach or its modifications in JNA. Radiation therapy may be recommended for patients with small residual tumor.
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Affiliation(s)
- Vasily A Cherekaev
- Department of Skull Base and Craniofacial Surgery, N.N. Burdenko Neurosurgical Institute, 4th Tverskaya-Yamskaya str., 16, 125047, Moscow, Russia.
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Kukwa W, Andrysiak R, Kukwa A, Hubalewska-Dydejczyk A, Gronkiewicz Z, Wojtowicz P, Krolicki L, Wierzchowski W, Grochowski T, Czarnecka AM. 99mTC-octreotide scintigraphy and somatostatin receptor subtype expression in juvenile nasopharyngeal angiofibromas. Head Neck 2011; 33:1739-46. [DOI: 10.1002/hed.21668] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 09/02/2010] [Accepted: 10/04/2010] [Indexed: 11/08/2022] Open
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Renkonen S, Hagström J, Vuola J, Niemelä M, Porras M, Kivivuori SM, Leivo I, Mäkitie AA. The changing surgical management of juvenile nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 2010; 268:599-607. [PMID: 20848119 DOI: 10.1007/s00405-010-1383-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 09/02/2010] [Indexed: 11/28/2022]
Abstract
The management of juvenile nasopharyngeal angiofibroma (JNA) has changed during the last decades but it still continues to be a challenge for the multidisciplinary head and neck surgical team. The aim of this study was to review the used treatment approach and outcome of JNA in a single institution series of 27 patients diagnosed and treated during the years 1970-2009. All patients were male, with the median age of 17 years (range 11-33 years). Surgery was used as the primary treatment in every case. Surgical approaches varied, transpalatal approach (N = 14) being the most common approach used in this series. During the last decade various other techniques were applied, including endoscopic (N = 3) resection. Two patients were additionally treated with antiangiogenic agents and one patient with stereotactic radiotherapy. The primary recurrence rate was 37% and it seemed to correlate with vascular density of tumour and the surgical approach used. We suggest that the management of JNA should be planned by an experienced head and neck surgeon, as part of a multidisciplinary team, preferably in a tertiary referral setting, and the recent development of the available therapies should be taken into account to minimise the risk of recurrence.
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Affiliation(s)
- Suvi Renkonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, 00029, Helsinki, Finland
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Satogami N, Okada T, Koyama T, Gotoh K, Kamae T, Togashi K. Visualization of external carotid artery and its branches: Non-contrast-enhanced MR angiography using balanced steady-state free-precession sequence and a time-spatial labeling inversion pulse. J Magn Reson Imaging 2009; 30:678-83. [PMID: 19711418 DOI: 10.1002/jmri.21883] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Naoe Satogami
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Khalifa MA, Ragab SM. Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension. Int J Pediatr Otorhinolaryngol 2008; 72:1855-60. [PMID: 18952302 DOI: 10.1016/j.ijporl.2008.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 08/22/2008] [Accepted: 09/02/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of endoscopic assisted antral window approach in advanced nasopharyngeal angiofibroma with infratemporal fossa extension. MATERIALS AND METHODS Sixteen cases diagnosed as juvenile nasopharyngeal angiofibroma type III with infratemporal fossa extension were surgically managed using endoscopic assisted antral window approach (group A) and compared with another group of similar number that were managed using endoscopic assisted midfacial degloving (group B). Inclusion criteria were type III JNA with infratemporal fossa extension and a minimum follow-up of 2 years. Operative time, blood loss, adverse events and recurrences were recorded in all cases. RESULTS The amount of blood lost in group A was significantly less than group B. The operative time of group A was significantly less than group B. No major complications were seen in both groups. Twenty-eight patients showed complete tumor clearance. Four recurrences were seen: two in group A and two in group B. CONCLUSION Endoscopic assisted antral window approach provides a safe, reliable, effective and minimally invasive technique in management of type III JNA with infratemporal fossa extension. Preoperative embolization is a safe measure in the experienced hands that helps to reduce intraoperative blood loss and improves the quality of the surgical field.
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Affiliation(s)
- Mohamed A Khalifa
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Egypt
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Carrillo J, Maldonado F, Albores O, Ramírez-Ortega M, Oñate-Ocaña L. Juvenile nasopharyngeal angiofibroma: Clinical factors associated with recurrence, and proposal of a staging system. J Surg Oncol 2008; 98:75-80. [DOI: 10.1002/jso.21062] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Danesi G, Panciera DT, Harvey RJ, Agostinis C. Juvenile nasopharyngeal angiofibroma: Evaluation and surgical management of advanced disease. Otolaryngol Head Neck Surg 2008; 138:581-6. [DOI: 10.1016/j.otohns.2008.01.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 10/05/2007] [Accepted: 01/23/2008] [Indexed: 11/24/2022]
Abstract
Objective Evaluate preoperative imaging in predicting operative stage. Describe the outcomes in surgically treated juvenile nasopharyngeal angiofibroma (JNA) with the influence of middle cranial fossa, carotid, or dural involvement on recurrence. Study Design Retrospective cohort of surgically treated patients with JNA. Subjects and Methods Eighty-five patients from a regional Italian referral center were assessed for recurrence, radiologic, and operative staging. High risk areas involved were recorded at surgery. Results Recurrence for advanced disease (IIIb+) was 18.2% (6 of 33) and 15.3% (13 of 85) overall. Preoperative staging poorly correlated with operative stage ( P = 0.15). No single high risk area was predictive for recurrence, but the absence of any risk factor was associated with a favorable outcome ( P < 0.01). Conclusion Dural involvement by tumor is rare and imaging may overstage disease. Anterior access, endoscopic or open, is sufficient to address intracranial involvement. When an open approach is used, a midface degloving technique affords excellent exposure even for advanced disease. Lateral approaches with their associated morbidity can be reserved for selected recurrent disease.
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Maroldi R, Ravanelli M, Borghesi A, Farina D. Paranasal sinus imaging. Eur J Radiol 2008; 66:372-86. [PMID: 18375083 DOI: 10.1016/j.ejrad.2008.01.059] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 01/17/2008] [Indexed: 12/01/2022]
Abstract
Endonasal surgery is currently extending its application beyond inflammatory sinonasal lesions to successfully treat both benign and malignant neoplasms. This progression has been possible by the detailed information provided by imaging techniques (CT, MRI and PET). Inflammatory diseases are the "domain" of CT. CT provides excellent details about the thin bony sinonasal walls separating the ethmoid from the anterior skull base and the orbit. Benign and malignant neoplasms are the "domain" of MRI because the tumor is more easily separated from adjacent structures, the periosteal linings (periorbita, dura mater) and perineural spread can be accurately shown. Whereas MRI precisely assess pre-treatment tumor extent, early submucosal local recurrences are difficult to demonstrate because of post-treatment changes of the anatomy and of the signal of treated tissues. Though diffusion-weighted imaging and dynamic contrast-enhanced techniques are promising developments, PET-CT may overcome the limits of morphological MRI.
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Affiliation(s)
- Roberto Maroldi
- Department of Radiology, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy.
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MR angiography at 3 T for assessment of the external carotid artery system. AJR Am J Roentgenol 2007; 189:1088-94. [PMID: 17954645 DOI: 10.2214/ajr.07.2235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A number of clinical situations exist in which high-resolution depiction of the external carotid artery system is required, a task not previously addressed by MR angiography. The purpose of this study was to evaluate the extent to which high-spatial-resolution MR angiography at 3 T can be used to map the normal external carotid artery system. SUBJECTS AND METHODS Twenty-three consenting adult patients were prospectively evaluated. Images acquired were evaluated by two independent observers, and each branch vessel was scored with regard to image quality, presence and grade of stenoses, and artifacts. Interobserver agreement regarding image quality and the presence and degree of stenosis was tested using the kappa coefficient. Differences in quality ratings between the two observers were assessed using the paired Student's t test. RESULTS Of 828 vessels analyzed, 92.63% were designated of diagnostic quality with no significant difference between the observers' image quality scores (p = 0.63). Good agreement was determined regarding image quality achieved (kappa = 0.716). All examinations were free of artifact sufficient to interfere with confident interpretation. Excellent correlation was seen with regard to stenosis detection and grading (kappa = 0.857). Of the external carotid artery systems assessed, 82.6% showed conventional anatomic vascular branching. CONCLUSION High-spatial-resolution, 3D contrast-enhanced MR angiography at 3 T using sagittal source data acquisition and an advanced acceleration factor of 6 allows high-quality (92.63% of arterial segments) visualization of the external carotid artery system, with complete head and neck vascular coverage.
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Carrillo JF, Albores O, Ramírez-Ortega MC, Aiello-Crocifoglio V, Oñate-Ocaña LF. An audit of nasopharyngeal fibromas. Eur J Surg Oncol 2007; 33:655-61. [PMID: 17329064 DOI: 10.1016/j.ejso.2007.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Accepted: 01/08/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Nasopharyngeal angiofibroma (NA) is a vascular tumor of the nasopharynx of young males which presents rarely. Our aim was to analyse outcome and prognostic factors of a case series of NA. MATERIALS AND METHODS We conducted a retrospective study of patients with diagnosis of NA treated at a single institution from 1981 to 2003. We evaluated clinical, radiological and therapeutic data for recurrence- and disease-free survival-associated prognostic factors. Bi- and multivariate analyses were performed. RESULTS Fifty-four males with NA constitute our study group. Age varied from 12 to 35 years (mean, 18.5 years; standard deviation [SD], 4.9). There were 18 recurrences; localization in nasopharynx, nasal fossae or maxillary antrum was not associated with recurrences. Invasion to pterygomaxillary fossae, to infratemporal fossae or to skull base and/or intracranial extension were associated with recurrences in two of 14, in five of 12, and in 11 of 18 cases, respectively. Tumors < or >or=6 cm were associated with zero and with 18 recurrences, respectively (p<0.01). Multivariate analyses conferred statistical significance (p<0.01) to a model including patterns of extension, tumor size in pterygomaxillary or anterior infratemporal fossa invasion, and surgical margins. CONCLUSION Recurrence factors for NA are defined and consequently treatment design is suggested. Endoscopic approaches could be considered in patients with minor lateral extensions, while wide surgical approaches are indicated in invasive cases. Radiotherapy could be applied alone or combined with surgery for extensive intracranial involvement.
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Affiliation(s)
- J F Carrillo
- Head and Neck Department, Surgery División, Instituto Nacional de Cancerologia, Mexico City, Mexico.
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Affiliation(s)
- B Schick
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universität Erlangen-Nürnberg, Waldstr. 1, 91054, Erlangen.
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