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Fujii M, Yokoyama K, Tanaka Y, Kobayashi D, Tateishi U. A Rare Case of Sphenoid Sinus Hemangioma With Intrasellar and Cavernous Sinus Extension. Cureus 2024; 16:e61034. [PMID: 38800783 PMCID: PMC11128068 DOI: 10.7759/cureus.61034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 05/29/2024] Open
Abstract
Sphenoid sinus hemangiomas are uncommon and pose significant diagnostic challenges due to their rarity and the complex symptoms associated with their critical anatomical location. This report discusses a woman in her 40s who presented with worsening headaches, diplopia, and a sensation of pressure behind her eyes. Diagnostic imaging revealed a lobulated mass in the sphenoid sinus extending into the cavernous sinus and sella, initially mimicking an aggressive neoplastic pathology. However, histopathological examination following endovascular embolization and partial surgical resection confirmed the diagnosis of a cavernous hemangioma. This case highlights the importance of considering hemangiomas in the differential diagnosis of sphenoid sinus masses, especially when patients present with atypical symptoms and imaging shows features such as high vascularity and bone remodeling. The findings emphasize the need for careful diagnostic and therapeutic approaches to effectively manage such cases and differentiate them from more aggressive pathologies.
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Affiliation(s)
- Mikiya Fujii
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, JPN
| | - Kota Yokoyama
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, JPN
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, JPN
| | - Daisuke Kobayashi
- Department of Pathology, Nerima-Hikarigaoka Hospital, Tokyo, JPN
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, JPN
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, JPN
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Kim HJ, Lee YH, Lee SH, Seo MY. Endoscopic removal of sinonasal hemangioma using vessel sealing device without tumor embolization. Clin Case Rep 2023; 11:e8148. [PMID: 37927978 PMCID: PMC10622400 DOI: 10.1002/ccr3.8148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
When massive bleeding is anticipated during endoscopic sinonasal tumor removal, a vessel sealing device is useful for successful tumor removal.
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Affiliation(s)
- Hong Jin Kim
- Department of Otorhinolaryngology – Head and Neck Surgery, Division of Rhinology and Sleep MedicineKorea University College of Medicine, Korea University Ansan HospitalAnsan‐siSouth Korea
| | - Ye Hwan Lee
- Department of Otorhinolaryngology – Head and Neck Surgery, Division of Rhinology and Sleep MedicineKorea University College of Medicine, Korea University Ansan HospitalAnsan‐siSouth Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology – Head and Neck Surgery, Division of Rhinology and Sleep MedicineKorea University College of Medicine, Korea University Ansan HospitalAnsan‐siSouth Korea
| | - Min Young Seo
- Department of Otorhinolaryngology – Head and Neck Surgery, Division of Rhinology and Sleep MedicineKorea University College of Medicine, Korea University Ansan HospitalAnsan‐siSouth Korea
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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López F, Triantafyllou A, Snyderman CH, Hunt JL, Suárez C, Lund VJ, Strojan P, Saba NF, Nixon IJ, Devaney KO, Alobid I, Bernal-Sprekelsen M, Hanna EY, Rinaldo A, Ferlito A. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017; 39:1033-1045. [PMID: 28199045 DOI: 10.1002/hed.24696] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022] Open
Abstract
Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Asterios Triantafyllou
- Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK.,School of Dentistry, University of Liverpool, Liverpool, UK
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Carlos Suárez
- Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Valerie J Lund
- Professorial Unit, Ear Institute, University College London, London, UK
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Iain J Nixon
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | | | - Isam Alobid
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Thakar A, Hota A, Bhalla AS, Gupta SD, Sarkar C, Kumar R. Overt and occult vidian canal involvement in juvenile angiofibroma and its possible impact on recurrence. Head Neck 2015; 38 Suppl 1:E421-5. [DOI: 10.1002/hed.24012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 11/24/2014] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Alok Thakar
- Department of Otolaryngology and Head and Neck Surgery; All India Institute of Medical Sciences; New Delhi
| | - Ashutosh Hota
- Department of Otolaryngology and Head and Neck Surgery; All India Institute of Medical Sciences; New Delhi
| | - Ashu Seth Bhalla
- Department of Radiodiagnosis; All India Institute of Medical Sciences; New Delhi
| | | | - Chitra Sarkar
- Department of Pathology; All India Institute of Medical Sciences; New Delhi
| | - Rakesh Kumar
- Department of Otolaryngology and Head and Neck Surgery; All India Institute of Medical Sciences; New Delhi
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Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Invasive growth patterns of juvenile nasopharyngeal angiofibroma: radiological imaging and clinical implications. Acta Radiol 2014; 55:725-31. [PMID: 24132768 DOI: 10.1177/0284185113506189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile nasopharyngeal angiofibroma is a benign lesion with locally aggressive nature. Knowledge of its typical growth patterns is crucial for precise preoperative staging and adequate preoperative patient counseling. This pictorial essay focuses on characteristic radiological features and paths of invasive growth of this rare tumor. Also, the impact of accurate preoperative evaluation of tumor extensions on surgical planning and results of treatment are discussed.
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Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Marcin Szymański
- Department of Otolaryngology, Medical University of Lublin, Poland, Lublin
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Khoueir N, Nicolas N, Rohayem Z, Haddad A, Abou Hamad W. Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma. Otolaryngol Head Neck Surg 2013; 150:350-8. [DOI: 10.1177/0194599813516605] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications. Data Sources Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. Review Methods The literature was searched by 2 reviewers with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models. Results Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (minimum, 20 mL; maximum, 1482 mL). It was 414.6 mL (minimum, 20 mL; maximum, 1000 mL) and 774.2 mL (minimum, 228 mL; maximum, 1482 mL), respectively, in the group with and without embolization. No conclusion could be made because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval [CI], 8.3-11.7). It was 9.3% (95% CI, 7.2-11.5) for complications and 7.7% (95% CI, 5.4-10.1) for residual tumor. Conclusion The endoscopic treatment is an evolving modality. It is considered today the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.
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Affiliation(s)
- Nadim Khoueir
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Nicolas Nicolas
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Ziad Rohayem
- Otolaryngology–Head and Neck Surgery, Saint-Elizabeth Medical Center, Brighton, Massachusetts, USA
| | - Amine Haddad
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Walid Abou Hamad
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
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Lega BC, Kramer DR, Newman JG, Lee JYK. Morphometric measurements of the anterior skull base for endoscopic transoral and transnasal approaches. Skull Base 2012; 21:65-70. [PMID: 22451802 DOI: 10.1055/s-0030-1265825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study is to determine the bony limits of the transnasal and transoral approaches to the anterior skull base. The data we present are meant to assist surgeons in preoperative planning for lesions of the sella, clivus, foramen magnum, and odontoid. Using precise measurements undertaken on 41 high-resolution computed tomography scans from patients at the University of Pennsylvania without any history of sinus or sellar pathology, we sought to define the bony limits of transoral and transnasal approaches. Direct measurements and calculated angles were used to assess the dimensions of the anterior skull base. Using our measurements, a transnasal approach can reach an average of 22.5 mm below the plane of the hard palate to the body of C2, and a transoral route can reach 38 mm above the basion along the length of the clivus. Analysis of variance demonstrated no significant differences when subjects were grouped based on race or gender. The measurements outlined within this article help to define the relative dimensions necessary for adapted transoral and transnasal skull base surgeries.
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Duval M, Hwang E, Kilty SJ. Systematic review of treatment and prognosis of sinonasal hemangiopericytoma. Head Neck 2012; 35:1205-10. [PMID: 22733718 DOI: 10.1002/hed.23074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND This study was undertaken to determine the recurrence rate for open and endoscopic surgery and the clinical prognosis of this sinonasal tumor. METHODS A systematic review of individual cases of sinonasal hemangiopericytoma was performed. A total of 97 articles were included in the study and reviewed to extract the relevant information about each case. RESULTS In all, 194 cases of sinonasal hemangiopericytoma were identified. There were 53 recurrences (27.3%), 6 tumor-related deaths (3.1%), and 4 cases of metastases (2.1%). There was no significant difference between rate of recurrence for endoscopic or open resection (p = .06). Incomplete excision was the most important predictor of recurrence (odds ratio = 11.50, 95% confidence interval 3.76-36.82, p < .001). Radiotherapy may be advantageous in cases of incomplete surgical resection (p = .03). CONCLUSIONS Complete excision is essential to minimize tumor recurrence and radiotherapy may decrease the rate of recurrence in the case of incomplete resection. Current evidence does not suggest that open resection is superior to endoscopic resection.
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Affiliation(s)
- Melanie Duval
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Martínez-Capoccioni G, Martín-Martín C, Espinosa-Restrepo F. Transnasal endoscopic resection of a nasopharyngeal pleomorphic adenoma: a rare case report. Eur Arch Otorhinolaryngol 2012; 269:2009-13. [DOI: 10.1007/s00405-012-2003-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 03/15/2012] [Indexed: 11/25/2022]
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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: 31] [Impact Index Per Article: 2.6] [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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Abstract
Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent epistaxis and nasal obstruction. Although the use of nonsurgical therapies is described in the literature, surgery is currently considered the ideal treatment for juvenile angiofibroma. Refinement in preoperative embolization has provided significant reduction of complications and intraoperative bleeding with minimal risk of residual disease. During the last decade, an endoscopic technique has been extensively adopted as a valid alternative to external approaches in the management of small-intermediate size juvenile angiofibromas. Herein, we review the evolution in the management of juvenile angiofibroma with particular reference to recent advances in diagnosis and treatment.
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Nicolai P, Villaret AB, Farina D, Nadeau S, Yakirevitch A, Berlucchi M, Galtelli C. Endoscopic surgery for juvenile angiofibroma: a critical review of indications after 46 cases. Am J Rhinol Allergy 2010; 24:e67-72. [PMID: 20338105 DOI: 10.2500/ajra.2010.24.3443] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND At present, transnasal endoscopic surgery is considered a viable option in the management of small-intermediate size juvenile angiofibromas (JAs). The authors critically review their 14-year experience in the management of this lesion to refine selection criteria for an endoscopic approach. METHODS From January 1994 to May 2008, 46 patients were treated by a pure endoscopic resection after vascular embolization (87%). The lesions were classified according to Andrews (Andrews JC, et al., The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach, Laryngoscope 99:429-437, 1989) and Onerci (Onerci M, et al. Juvenile nasopharyngeal angiofibroma: A revised staging system, Rhinology 44:39-45, 2006) staging systems. All patients were followed by regular endoscopic and magnetic resonance imaging (MRI) examinations. RESULTS Lesions were classified as follows: stage I, n = 5; stage II, n = 24; stage IIIa, n = 14; stage IIIb, n = 3 according to Andrews classification system; stage 1, n = 9; stage II, n = 12; stage III, n = 26 according to Onerci's system. Unilateral blood supply was detected in 39 (85%) cases. Feeding vessels from the internal carotid artery (ICA) were also reported in 14 (30%) patients. Intraoperative blood loss ranged from 250 to 1300 mL (mean, 580 mL). In four (8.7%) cases, suspicious residual disease was detected by MRI. In one patient, a 1-cm persistent lesion was endoscopically removed because septoplasty was required and a slight increase in size was noticed. The other three lesions, all located in the root of the pterygoid plate, are nearly stable in size and are currently under MRI follow-up. CONCLUSION The improvement of surgical instrumentation and the experience acquired during a 14-year period have contributed to expanding the indications for endoscopic surgery in the management of JAs. Even stage III lesions may be successfully managed, unless the ICA is encased or if it provides an extensive blood supply. An external approach may be required when critical structures such as the ICA, cavernous sinus, or optic nerve are involved by lesions that are persistent after previous treatment; such a situation may prevent safe and radical dissection with a pure endoscopic approach. Better understanding of the factors influencing the growth of residual lesions is needed to differentiate those requiring re-treatment from those which can be simply observed.
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Affiliation(s)
- Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Anderson S, Panizza B. Are cell salvage and autologous blood transfusion safe in endonasal surgery? Otolaryngol Head Neck Surg 2010; 142:S3-6. [PMID: 20176278 DOI: 10.1016/j.otohns.2009.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 09/21/2009] [Accepted: 10/02/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Endoscopic transnasal approaches to the skull base and intracranial disease are an emerging subspecialty. The limits of this approach are often dictated by exposure and blood loss. Cell salvage techniques are widely used in other surgical fields. However, in otolaryngology, questions remain regarding its safety because work is performed in a contaminated field. In this literature review, we present the evidence for perioperative cell saver blood transfusion in potentially contaminated fields and the need for further investigation of its use in endonasal surgery. DATA SOURCES MEDLINE and Evidence Based Medicine Reviews databases were searched for relevant articles. REVIEW METHODS All English articles discussing autologous blood transfusion in endonasal surgery were reviewed. RESULTS Despite a wide search pattern, no articles that discuss this topic were found in the English literature. Therefore, we went on to present data on the general use of cell saver blood in contaminated fields. CONCLUSION Cell saver blood is widely accepted in surgery. It offers many advantages in elective operations in which blood loss is expected to be significant. Cell saver blood has been transfused from contaminated fields in other forms of surgery without an associated increase in morbidity. There is good evidence that antibiotic prophylaxis is mandatory in this setting. There is no direct evidence that cell salvage blood is safe in endonasal surgery. Cell salvage is part of a multimodality approach, including the use of hypotensive anesthesia, topical procoagulants, a dedicated team with appropriate equipment, and a good surgical technique with a focus on hemostasis.
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Affiliation(s)
- Shane Anderson
- The University of Queensland, The Princess Alexandra Hospital, Department of Otolaryngology-Head and Neck Surgery, Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
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Margalit N, Wasserzug O, De-Row A, Abergel A, Fliss DM, Gil Z. Surgical treatment of juvenile nasopharyngeal angiofibroma with intracranial extension. Clinical article. J Neurosurg Pediatr 2009; 4:113-7. [PMID: 19645542 DOI: 10.3171/2009.4.peds08321] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Nevo Margalit
- Skull Base Surgery Service, Tel-Aviv University, Tel-Aviv, Israel
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Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999-2007. Am J Rhinol Allergy 2009; 23:328-30. [PMID: 19490810 DOI: 10.2500/ajra.2009.23.3322] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Over the past 10 years, the management of juvenile nasopharyngeal angiofibroma (JNA) has been redefined because of the improvement of transnasal skull base techniques. However, the limits of endoscopic resection still have to be fully defined. The purpose of this study was to report on a series of patients presenting with JNA in an effort to further define an optimal treatment algorithm and improve outcomes. METHODS A retrospective review was performed of 18 patients presenting to a tertiary care institution with JNA from 1999 to 2007. Patients were categorized by Andrews stage and data were collected on presentation, operative technique, and postoperative course. RESULTS All patients underwent preoperative embolization. Stages 1, 2, and one 3a lesions were approached endoscopically while the remainder underwent open resection. In the endoscopic group the intraoperative blood loss was almost half that of the open group (506 versus 934 mL) and the average hospital stay was 1 day less (3 vs. 4 days). CONCLUSION Endoscopic resection is reasonable for Andrews stage 1, 2, and select 3a lesions and may allow for less bleeding and a shorter hospital stay. This study supports the current trend of expansion of indications for endoscopic JNA resection.
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Affiliation(s)
- Benjamin S Bleier
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104-4206, USA.
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Hackman T, Snyderman CH, Carrau R, Vescan A, Kassam A. Juvenile Nasopharyngeal Angiofibroma: The Expanded Endonasal Approach. Am J Rhinol Allergy 2009; 23:95-9. [DOI: 10.2500/ajra.2009.23.3271] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressively vascular tumor that may involve the skull base and extend intracranially. Endoscopic excision has become the new standard for smaller tumors but remains a challenge for large tumors, leading some to advocate radiation therapy. We reviewed our experience managing JNA, specifically with respect to utility of the expanded endonasal approach (EEA) for lesions with skull base and intracranial extension. Methods All cases of JNA at the University of Pittsburgh Medical Center from 1995 to 2006 were reviewed with respect to tumor size and location, vascular supply and results of embolization, skull base involvement and intracranial extension, surgical approach, blood loss, intraoperative and postoperative complications, and recurrence. Results Thirty-one cases of JNA were identified. The majority of tumors were completely excised using the EEA, regardless of size or extension into adjacent compartments. Surgical excision of some tumors with intracranial blood supply was staged. Recurrence rates were not associated with extent of tumor or surgical technique. Long-term morbidity was minimal. Conclusion Most JNA, regardless of tumor extent, may be completely excised using EEA alone or in combination with minor sublabial incisions avoiding the morbidity associated with larger open approaches or postoperative radiation therapy.
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Affiliation(s)
- Trevor Hackman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carl H. Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ricardo Carrau
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allan Vescan
- Department of Otolaryngology, University of Toronto, Toronto, Canada
| | - Amin Kassam
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Socher JA, Cassano >M, Filheiro CA, Cassano P, Felippu A. Diagnosis and treatment of isolated sphenoid sinus disease: a review of 109 cases. Acta Otolaryngol 2008; 128:1004-10. [PMID: 19086308 DOI: 10.1080/00016480701793735] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION Endoscopic transethmoidal sphenoidotomy performed mainly in the early stages of the pathology and by expert hands is [WX1]very effective in treating isolated sphenoid sinus disease. OBJECTIVE This study aimed to investigate the causes of isolated sphenoid sinus disease identified in 109 patients and report on the most appropriate diagnostic and therapeutic patterns for an earlier diagnosis and a successful treatment of the disease. SUBJECTS AND METHODS A total of 109 subjects with various isolated sphenoid pathologies were first examined by general objective examination, nasal sinus endoscopy, CT scan of paranasal sinuses, and in some cases with MRI. Then, they underwent medical and/or surgical treatment. RESULTS Nineteen patients (17.43%) had isolated sphenoiditis, 6 (5.5%) fungal sinusitis, 30 (27.52%) mucocele, 6 (5.5%) fibrous dysplasia, 6 (5.5%) meningoencephalocele, 5 (4.58%) inverted papilloma, 4 (3.66%) epidermoid carcinoma, 10 (9.17%) liquor fistula, 1 (0.9%) rhabdomyosarcoma, 1 (0.9%) chordoma, and 1 (0.9%) had carotid pseudoaneurysm. Evidence of definitive diagnosis by endoscopy was obtained in less than half of the cases. CT scan, however, sometimes in combination with MRI, determined the pathology in all the cases. A follow-up of at least 4 years post-surgery showed good results in all the patients who underwent endoscopic transethmoidal sphenoidotomy.
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Gardner PA, Kassam AB, Rothfus WE, Snyderman CH, Carrau RL. Preoperative and intraoperative imaging for endoscopic endonasal approaches to the skull base. Otolaryngol Clin North Am 2008; 41:215-30, vii. [PMID: 18261533 DOI: 10.1016/j.otc.2007.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endoscopic endonasal approaches are being used with increasing frequency to provide access to virtually any anterior cranial base, clival, or anterior craniocervical pathology. The radiographic evaluation of skull base anatomy and its relationship to associated tumors is critical for both preoperative planning and intraoperative guidance, to ensure the safety and efficacy of these techniques. CT and MRI play a complementary role in guiding endoscopic endonasal procedures.
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Affiliation(s)
- Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh, 200 Lothrop Street, Suite B400, Pittsburgh, PA 15213, USA.
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20
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Nemec S, Formanek M, Czerny C. [Postoperative imaging of paranasal sinuses]. Radiologe 2008; 47:621-7. [PMID: 17549448 DOI: 10.1007/s00117-007-1506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The radiological interpretation of postoperative changes of the paranasal sinuses requires knowledge of why and how the surgical intervention was performed and what the basic clinical findings were. It is important to know whether there was an inflammation, a reconstructive procedure, or a tumorous process. Multidetector computed tomography (MDCT) evaluated in a high-resolution bone window level setting represents the method of choice for imaging after nonfunctional and functional procedures after inflammatory changes as well as for imaging after reconstructive surgery because of facial trauma or before dental implantation. In the postoperative follow-up of tumor patients contrast-enhanced MDCT evaluated in a soft tissue window and bone window and especially magnetic resonance imaging (MRI) represent the standard. In many cases it is possible to differentiate tumor recurrence from inflammation with the help of contrast-enhanced multiplanar MRI and to detect bone marrow changes prior to CT.
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Affiliation(s)
- S Nemec
- Abt. für Osteologie, Klinik für Radiodiagnostik, AKH/Medizinische Universität Wien.
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