Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension.

Danesi, Giovanni, Panizza, Benedict, Mazzoni, Antonio and Calabrese, Vincenzo (2000) Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension.. Otolaryngology - Head and Neck Surgery, 122 2: 277-283. doi:10.1016/S0194-5998(00)​70256-7


Author Danesi, Giovanni
Panizza, Benedict
Mazzoni, Antonio
Calabrese, Vincenzo
Title Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension.
Journal name Otolaryngology - Head and Neck Surgery   Check publisher's open access policy
ISSN 0194-5998
1097-6817
Publication date 2000-02
Year available 2000
Sub-type Article (original research)
DOI 10.1016/S0194-5998(00)​70256-7
Volume 122
Issue 2
Start page 277
End page 283
Total pages 7
Place of publication Thousand Oaks, CA United States
Publisher Sage Publications Inc.
Collection year 2001
Language eng
Formatted abstract
Although surgery is regarded as the mainstay of treatment for juvenile nasopharyngeal angiofibromas (JNAs), ancillary treatment modalities such as radiotherapy and on rare occasions chemotherapy are still recommended by many for intracranial extension with apparent radiologic involvement of the cavernous sinus and internal carotid artery. Further, most authors undertaking surgical excision of this subgroup of patients would recommend a lateral or combined frontal and lateral approach for its removal. In a series of 49 cases of JNA, 14 were found during surgery to have intracranial extradural extension; the anterior approach was used for their removal. Although in these cases, on radiography the cavernous sinus often looked to be invaded and the internal carotid artery was displaced superolaterally, there was no difficulty in establishing a plane of dissection. Total removal was achieved in 11 of the 14 cases with a single-stage procedure. Of the 3 cases with residual tumor, only 1 occurred intracranially. Removal was achieved by a subtemporal approach in this case. For the extracranial residual tumors I required a midface degloving and the other, with a 1-cm residual tumor in the nasopharynx, has been treated conservatively for 6 years with no evidence of growth. No deaths or significant complications have occurred, and radiotherapy has not been required. We conclude that JNAs are tumors with a predilection for spread but that rarely invade dura, acting instead to displace it. We believe that surgery is the method of choice for treating these lesions and that an anterior surgical approach with microsurgical techniques should be used in the first instance. In the last 2 cases we preferred a midface degloving technique to avoid facial scarring and because this approach allows a widening of the surgical field if needed by the performance of bilateral maxillary free bone flaps. On the rare occasion that a lateral approach, with its attendant permanent conductive hearing loss, is found to be necessary for total tumor removal, this can be done as a staged procedure. This may be necessary when the tumor has spread lateral to the horizontal internal carotid artery.
Keyword Adolescent
Neoplasm Invasiveness
Tomography
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Sat, 25 Jan 2014, 13:32:55 EST by Dr Benedict Panizza on behalf of Surgery - Princess Alexandra Hospital