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Safhi FA, Al-Hazani TMI, Jalal AS, Alduwish MA, Alshaya DS, Almufareh NA, Domiaty DM, Alshehri E, Al-Shamrani SM, Abboosh TS, Alotaibi MA, Alwaili MA, Al-Qahtani WS. FGFR3 and FGFR4 overexpression in juvenile nasopharyngeal angiofibroma: impact of smoking history and implications for personalized management. J Appl Genet 2023; 64:749-758. [PMID: 37656292 DOI: 10.1007/s13353-023-00780-w] [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] [Received: 07/06/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
Lifestyle factors, including smoking, have been linked to neoplastic diseases, and reports suggest an association between smoking and overexpression of FGFR (fibroblast growth factor receptor) in certain neoplasms. This study aims to assess the expression of FGFR3 and FGFR4 genes in patients with and without a history of smoking.A total of 118 participants were recruited, including 83 Juvenile Nasopharyngeal Angiofibroma (JNA) patients and 35 healthy participants, the JNA patients were further stratified as smokers and nonsmokers. Total RNA was extracted from the blood & saliva sample by using TRIzol reagent, and quantified using a Nanodrop, and then subjected to gene expression analysis of FGFR3/4 using RT-PCR. Immunohistochemistry analysis was employed using fresh biopsies of JNA to validate the findings. All experiments were performed in triplicates and analysed using the Chi-Square test (P < 0.05). Smokers exhibited significantly lower total RNA concentrations across all sample types (P < 0.001). The study revealed significant upregulation of both FGFR3/4 genes in JNA patients (P < 0.05). Moreover, FGFR3 expression was significantly higher among smokers 66% (95% CI: 53-79%) compared to non-smokers 22% (95% CI: 18-26%). Immunohistochemistry analysis demonstrated moderate to strong staining intensity for FGFR3 among smokers. The study highlights the overexpression of FGFR3/4 genes in JNA patients, with a stronger association observed among smokers. Furthermore, medical reports indicated higher rates of recurrence and bleeding intensity among smokers. These findings emphasize the potential role of FGFR3 as a key molecular factor in JNA, particularly in the context of smoking.
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Affiliation(s)
- Fatmah Ahmed Safhi
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Tahani Mohamed Ibrahim Al-Hazani
- Department of Biology, College of Sciences and Humanities, Prince Sattam Bin Abdulaziz University, P.O. Box 83, 11940, Al-Kharj, Saudi Arabia
| | - Areej Saud Jalal
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Manal Abdullah Alduwish
- Department of Biology, College of Sciences and Humanities, Prince Sattam Bin Abdulaziz University, P.O. Box 83, 11940, Al-Kharj, Saudi Arabia
| | - Dalal S Alshaya
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Nawaf Abdulrahman Almufareh
- Department of Pediatric Dentistry and Preventive Dental Sciences, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Dalia Mostafa Domiaty
- College of Science, Department of Biology, University of Jeddah, P.O. Box 13151, 21493, Jeddah, Saudi Arabia
| | - Eman Alshehri
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Salha M Al-Shamrani
- College of Science, Department of Biology, University of Jeddah, P.O. Box 13151, 21493, Jeddah, Saudi Arabia
| | - Tahani Saeed Abboosh
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
- Public Security, Forensic Evidence Laboratories, Criminal Examinations, Ministry of Interior, Riyadh, Saudi Arabia
| | | | - Maha Abdulla Alwaili
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Wedad Saeed Al-Qahtani
- Department of Forensic Sciences, College of Criminal Justice, Naif Arab University for Security Sciences, P.O. Box 6830, 11452, Riyadh, Saudi Arabia.
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2
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Choi S, Zhang VJ, Zhu X, Ito CJ. Nasopharyngeal Angiofibroma in an Adult Male: A Case Report and Review of the Literature. Cureus 2023; 15:e49127. [PMID: 38125259 PMCID: PMC10732470 DOI: 10.7759/cureus.49127] [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: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
A 32-year-old male presented with recurrent bilateral epistaxis and nasal obstruction, leading to a rare diagnosis of nasopharyngeal angiofibroma. Although primarily observed in adolescents, this case underscores its presence in older populations. The patient underwent a successful endoscopic resection, contributing to the scant documented instances of such cases in adult U.S. males.
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Affiliation(s)
- Stephanie Choi
- Otolaryngology, UMass Chan Medical School, Worcester, USA
| | | | - Xiaoqin Zhu
- Pathology, UMass Chan Medical School, Worcester, USA
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3
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Bove I, Pangal DJ, Ruzevick JJ, Cheok S, Amar A, Mack W, Ference ED, Wrobel B, Swanson M, Hur K, Zada G. Anatomic Considerations Guiding Single Versus Multiportal Endoscopic Approaches for Resection of Juvenile Nasopharyngeal Angiofibroma: Cases Series With Graded Multicorridor Resections. Oper Neurosurg (Hagerstown) 2023; 25:150-160. [PMID: 37166983 DOI: 10.1227/ons.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Juvenile nasopharyngeal angiofibromas (JNAs) are characterized by expansive and destructive growth, often invading the midline/paranasal sinuses, pterygopalatine fossa, and infratemporal fossa and can extend into the orbit, cavernous sinus, or intracranially. OBJECTIVE To evaluete the major benefits of the extended endoscopic endonasal approach (EEA) for JNA resection as compared with more traditional and invasive transpalatal and transfacial approaches. When JNAs extend into lateral anatomic compartments, the optimal operative trajectory often requires additional approach strategies or surgical staging. METHODS We retrospectively reviewed 8 cases of large JNAs arising in symptomatic adolescent boys (University of Pittsburgh Medical Center Stages II, III, and V) and discuss anatomic and tumor considerations guiding the decision of a pure EEA vs combined EEA and sublabial transmaxillary approach (Caldwell-Luc). RESULTS A pure extended EEA was used in 6 JNA cases (UPMC Stages II-III); a multiportal EEA + Caldwell-Luc maxillotomy was used in 2 cases. One of the 2 patients (UPMC Stage V) previously treated with multiportal EEA + Caldwell-Luc maxillotomy underwent staged left temporal/transzygomatic craniotomy, obtaining gross total resection. Seven patients ultimately underwent complete removal without recurrence. One patient with a small residual JNA (UPMC II) underwent stereotactic radiosurgery without progression to date. CONCLUSION JNAs with lateral extension into the infratemporal fossa often benefited from additional lateral exposure using a Caldwell-Luc maxillotomy. Cases with significant skull base and/or dural involvement may undergo staged surgical treatment; temporalis + transzygomatic craniotomy is often useful for second-stage approaches for residual tumor in these lateral infratemporal or intracranial regions. SRS should be considered for residual tumor if additional surgery is not warranted.
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Affiliation(s)
- Ilaria Bove
- Department of Neurological Surgery, The University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Dhiraj J Pangal
- Department of Neurological Surgery, The University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jacob J Ruzevick
- Department of Neurological Surgery, The University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Stephanie Cheok
- Department of Neurological Surgery, The University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Arun Amar
- Department of Neurological Surgery, The University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - William Mack
- Department of Neurological Surgery, The University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Elisabeth D Ference
- USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Bozena Wrobel
- USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mark Swanson
- USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Kevin Hur
- USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurological Surgery, The University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Linton S, Mani N, Stockley H, Pathmanaban O. Management of a recurrent right juvenile nasopharyngeal angiofibroma using direct tumorous puncture embolisation and a subtemporal-preauricular infratemporal fossa surgical approach. BMJ Case Rep 2023; 16:e252862. [PMID: 36634988 PMCID: PMC9843186 DOI: 10.1136/bcr-2022-252862] [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: 01/13/2023] Open
Abstract
A juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular tumour that arises from the pterygopalatine fossa. It is seen near exclusively in young males though female cases have been reported. Symptoms are due to their high vascularity and mass effect. Commonly reported symptoms include: nasal obstruction, epistaxis and nasal discharge. The mainstay of treatment is surgical resection either via an endonasal endoscopic approach or open surgical resection. Preoperative embolisation has been shown to decrease intraoperative bleeding. Embolisation may be undertaken via a transarterial (TA) approach or, more recently, via direct tumorous puncture (DTP). Options for recurrent or residual disease may include revision surgery, radiotherapy or close clinical surveillance. The following case presentation describes the management of a recurrent JNA in an adult male using preoperative embolisation via a combination of TA and DTP embolisation and an open surgical resection via a subtemporal-preauricular infratemporal fossa approach.
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Affiliation(s)
- Stefan Linton
- Otolaryngology, Manchester Royal Infirmary, Manchester, UK
| | - Navin Mani
- ENT, Manchester Royal Infirmary, Manchester, UK
| | - Hannah Stockley
- Interventional Radiology, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
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Szyfter W, Balcerowiak A, Gawęcki W, Juszkat R, Wierzbicka M. Juvenile nasopharyngeal angiofibroma-20 years of experience in endoscopic treatment. Otolaryngol Pol 2021; 75:9-14. [PMID: 33949314 DOI: 10.5604/01.3001.0014.5220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. <br/>Aim: The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. <br/>Material and methods: The material covers 71 patients treated in the years 1985-2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or the double approach - external with the use of endoscopes, or only the endoscopic approach was used. In the entire population, external surgeries were performed in 37 patients, double access in 8 and endoscopic access in 26 patients. <br/>Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation.<br/> Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.
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Affiliation(s)
- Witold Szyfter
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Andrzej Balcerowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Robert Juszkat
- 2 Department of General and Procedural Radiology of the Poznan University of Medical Sciences, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
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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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Mandibular Intraosseous Angiofibroma-A Rare Clinical Entity. J Oral Maxillofac Surg 2020; 78:1343-1348. [PMID: 32360235 DOI: 10.1016/j.joms.2020.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/22/2022]
Abstract
Angiofibromas located in the maxillofacial region are rare and almost exclusively occur in adolescent males. These benign tumors are highly vascular, locally invasive, and commonly found in the nasopharyngeal space. In the present report, we describe a very rare case of an intraosseous mandibular angiofibroma in a 23-year-old male patient with histomorphologic and molecular confirmation. This type of tumor occurring in the mandible has been reported previously only once, to the best of our knowledge.
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8
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Transoral Finger-Retraction for Endonasal Endoscopic Resection of Masseteric and Buccal Space Lesions. J Craniofac Surg 2019; 30:800-802. [PMID: 30614990 DOI: 10.1097/scs.0000000000004931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lesions involving the masseteric and buccal spaces have traditionally required transoral or transcervical approaches. Herein, the authors describe the successful endonasal endoscopic resection of a juvenile nasopharyngeal angiofibroma (JNA) with significant extension into the masseteric and buccal spaces facilitated by transoral finger retraction. Juvenile nasopharyngeal angiofibromas are hypervascular tumors originating in the pterygopalatine fossa (PPF) with complex relationships to skull base and orbital structures. Endoscopic approaches have allowed for resection of JNAs with excellent visualization and without traditional transfacial approaches, decreasing morbidity and reducing incidence of facial deformity with similar outcomes as open approaches. While the endonasal endoscopic approach to the masseteric and buccal spaces is unconventional, encapsulated tumors in these regions can be delivered into the nasal cavity through the maxilla and PPF with the use of transoral finger-retraction. The authors present a case of a 10-year-old male referred to their tertiary care center with left-sided epistaxis, nasal obstruction, and facial swelling. Imaging demonstrated a vascular lesion in the PPF involving the left nasal cavity and paranasal sinuses, with extension into left middle cranial fossa, infratemporal fossa, orbit, and deep spaces of the neck including the masticator, masseteric, and buccal spaces. The patient underwent preoperative embolization and endoscopic endonasal surgical resection with transoral finger-retraction without complication. Transoral finger-retraction represents a supplemental technique that allows for encapsulated lesions involving the masseteric and buccal spaces to be delivered into the nasal cavity for endoscopic resection in a safe and effective fashion, preventing the need for transfacial incisions.
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9
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Camilon PR, Rahbar R, Cunningham MJ, Adil EA. Juvenile nasopharyngeal angiofibroma in prepubertal males: A diagnostic dilemma. Laryngoscope 2018; 129:1777-1783. [DOI: 10.1002/lary.27633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2018] [Indexed: 11/09/2022]
Affiliation(s)
- P. Ryan Camilon
- Department of Otolaryngology; Boston Medical Center; Boston Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Michael J. Cunningham
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Eelam A. Adil
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
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10
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Alvernia JE, Hidalgo J, Sindou MP, Washington C, Luzardo G, Perkins E, Nader R, Mertens P. The maxillary artery and its variants: an anatomical study with neurosurgical applications. Acta Neurochir (Wien) 2017; 159:655-664. [PMID: 28191601 DOI: 10.1007/s00701-017-3092-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques. The dimensions, course and branching patterns of the MA were recollected. In addition, 20 three-dimensional reconstruction CT head and neck angiograms (3D CTAs) of actual patients were correlated with the cadaveric findings. RESULTS The MA can be divided in three segments: mandibular, pterygoid and pterygopalatine. Medial and lateral trunk variants regarding its course around the lateral pterygoid muscle can be found. The different branching patterns of the MA have a direct correlation with the course of its main trunk at the base of the skull. Branching and trunk variants on one side do not predict the findings on the contralateral side. CONCLUSION In this study the highly variable course, branching patterns and relations of the MA are illustrated and described in human cadaveric heads and 3D CTAs. MA 3D CTA with bone reconstruction can be useful preoperatively for the identification of the medial or lateral course variants of this artery, particularly its pterygoid segment, which should be taken into account when considering the MA as a donor vessel for an EC-IC bypass.
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Affiliation(s)
- Jorge E Alvernia
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Hidalgo
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marc P Sindou
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | - Chad Washington
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gustavo Luzardo
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eddie Perkins
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Remi Nader
- Texas Center for Neuroscience, Houston, TX, USA
| | - Patrick Mertens
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
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11
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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: 64] [Impact Index Per Article: 9.1] [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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12
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Sanju HK, Bohra V, Sinha SK. Speech evoked auditory brainstem response and gap detection threshold in middle-aged individual. Eur Arch Otorhinolaryngol 2016; 274:2041-2048. [PMID: 27885514 DOI: 10.1007/s00405-016-4402-x] [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: 08/27/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
This study aimed at characterizing the gap detection threshold (GDT) and speech evoked ABR (SABR) in younger and middle-aged individuals. Two groups of subjects were participated in the study which includes 15 young adults in the age range of 15-25 years and 15 middle-aged individuals in the age range of 40-60 years. SABR with stimulus/da/of 40 ms and GDT were investigated on both groups. For SABR, Mann-Whitney U test revealed that ageing has significantly adverse effect on the encoding of F1 and F2 at brainstem level. However, no significant effect of ageing (till middle age) on the encoding of F0 was observed in present study. Mann-Whitney U test also showed significant longer latency of wave V in middle-aged individuals compared to younger adults. Furthermore, GDT was significantly better in younger adults compared to middle-aged individuals according to Mann-Whitney U test. This study also revealed no significant correlation between GDT and F0, F1, F2 for younger as well as middle-aged individuals. The findings of this study showed poor encoding of certain aspects of speech at brainstem level in middle-aged individuals compared to younger adults. This study also revealed deterioration of auditory processes in middle-aged individuals.
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Affiliation(s)
- Himanshu Kumar Sanju
- Department of Audiology and Speech Language Pathology, Amity Medical School, Amity University, Gurgaon, 122413, Haryana, India.
| | - Vaishnavi Bohra
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, 570006, Karnataka, India
| | - Sujeet Kumar Sinha
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, 570006, Karnataka, India
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Liu JK, Husain Q, Kanumuri V, Khan MN, Mendelson ZS, Eloy JA. Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach. J Neurosurg 2016; 124:1328-38. [DOI: 10.3171/2014.12.jns141696] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring.
METHODS
This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1–3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1–4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus.
RESULTS
A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications.
CONCLUSIONS
An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.
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Affiliation(s)
- James K. Liu
- Departments of 1Neurological Surgery and
- 2Otolaryngology–Head Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | | | | | | | - Jean Anderson Eloy
- Departments of 1Neurological Surgery and
- 2Otolaryngology–Head Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
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McLaughlin EJ, Cunningham MJ, Kazahaya K, Hsing J, Kawai K, Adil EA. Endoscopic Radiofrequency Ablation–Assisted Resection of Juvenile Nasopharyngeal Angiofibroma. Otolaryngol Head Neck Surg 2016; 154:1145-8. [DOI: 10.1177/0194599816630942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the feasibility of radiofrequency surgical instrumentation for endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) and to test the hypothesis that endoscopic radiofrequency ablation–assisted (RFA) resection will have superior intraoperative and/or postoperative outcomes as compared with traditional endoscopic (TE) resection techniques. Study Design Case series with chart review. Setting Two tertiary care pediatric hospitals. Subjects and Methods Twenty-nine pediatric patients who underwent endoscopic transnasal resection of JNA from January 2000 to December 2014. Results Twenty-nine patients underwent RFA (n = 13) or TE (n = 16) JNA resection over the 15-year study period. Mean patient age was not statistically different between the 2 groups ( P = .41); neither was their University of Pittsburgh Medical Center classification stage ( P = .79). All patients underwent preoperative embolization. Mean operative times were not statistically different ( P = .29). Mean intraoperative blood loss and the need for a transfusion were also not statistically different ( P = .27 and .47, respectively). Length of hospital stay was not statistically different ( P = .46). Recurrence rates did not differ between groups ( P = .99) over a mean follow-up period of 2.3 years. Conclusion There were no significant differences between RFA and TE resection in intraoperative or postoperative outcome parameters.
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Affiliation(s)
- Eamon J. McLaughlin
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael J. Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ken Kazahaya
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julianna Hsing
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Eelam A. Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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15
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Allensworth JJ, Troob SH, Lanciault C, Andersen PE. High-grade malignant transformation of a radiation-naïve nasopharyngeal angiofibroma. Head Neck 2016; 38 Suppl 1:E2425-7. [DOI: 10.1002/hed.24378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jordan J. Allensworth
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health and Science University; Portland Oregon
| | - Scott H. Troob
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health and Science University; Portland Oregon
| | - Christian Lanciault
- Department of Pathology; Oregon Health and Science University; Portland Oregon
| | - Peter E. Andersen
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health and Science University; Portland Oregon
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16
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Sun X, Guo L, Wang J, Wang H, Liu Z, Liu J, Yu H, Hu L, Li H, Wang D. Prognostic value of matrix metalloproteinase 9 expression in patients with juvenile nasopharyngeal angiofibroma: tissue microarray analysis. Int J Pediatr Otorhinolaryngol 2014; 78:1232-8. [PMID: 24969348 DOI: 10.1016/j.ijporl.2014.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/30/2014] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although JNA is a benign neoplasm histopathologically, it has a propensity for locally destructive growth and remains a higher postoperative recurrence rate. The aim of this study was to analyze the expression and localization of MMP-9 in JNA using tissue microarray to elucidate its correlation with clinicopathological features and recurrence. MATERIALS AND METHODS The expression of MMP-9 was assessed by immunohistochemistry in a tissue microarray from 70 patients with JNA and 10 control subjects. Correlation between the levels of MMP-9 expression and clinicopathologic variables, as well as tumor recurrence, were analyzed. RESULTS MMP-9 was detected in perivascular and extravascular less differentiated cells and stromal cells of patients with JNA but not in the matured vascular endothelial cells of these patients. The presence of MMP-9 expression in JNA was correlated with patient's age (p=0.001). Spearman correlation analysis suggested that high expression of MMP-9 in JNA had negative correlation with patient's age (r=-0.412, p<0.001). The recurrence rate in JNA patients with high MMP-9 expression was significantly higher than those with low MMP-9 expression (p=0.002). In multivariate and ROC curve analysis, MMP-9 was a good prognostic factor for tumor recurrence of JNA. CONCLUSION Higher MMP-9 expression is a poor prognostic factor for patients with JNA who have been surgically treated.
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Affiliation(s)
- Xicai Sun
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Limin Guo
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingjing Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuofu Liu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Juan Liu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huapeng Yu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Hu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Han Li
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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17
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Abstract
Benign sinonasal neoplasms are a heterogeneous group of tumors that present with similar symptoms including nasal obstruction, anosmia, rhinorrhea, and epistaxis. The proper workup and accurate diagnosis is essential for these tumors so that the appropriate treatment plan can be established. In this article of benign sinonasal neoplasms, we discuss their typical clinical presentation, histological and radiographic findings, and treatment options.
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Affiliation(s)
- Patrick T Hennessey
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins Sinus Center, Baltimore, Maryland 21287, USA
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18
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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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19
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Ballah D, Rabinowitz D, Vossough A, Rickert S, Dunham B, Kazahaya K, Cahill A. Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre. Clin Radiol 2013; 68:1097-106. [DOI: 10.1016/j.crad.2013.05.092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/09/2013] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
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20
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Iovanescu G, Ruja S, Cotulbea S. Juvenile nasopharyngeal angiofibroma: Timisoara ENT Department's experience. Int J Pediatr Otorhinolaryngol 2013; 77:1186-9. [PMID: 23732022 DOI: 10.1016/j.ijporl.2013.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/24/2013] [Accepted: 04/27/2013] [Indexed: 11/20/2022]
Abstract
UNLABELLED Juvenile nasopharyngeal angiofibroma is a histologically benign, but very aggressive and destructive tumor found exclusively in young males. The management of juvenile nasopharyngeal angiofibroma has changed in recent years, but it still continues to be a challenge for the multidisciplinary head and neck surgical team. OBJECTIVE The purpose of this study was to review a series of 30 patients describing the treatment approach used and studying the outcome of juvenile nasopharyngeal angiofibroma in the ENT Department Timisoara, Romania for a period of 30 years. METHODS The patients were diagnosed and treated during the years 1981-2011. All patients were male. Tumors were classified using Radkowski's staging system. Computed tomography and magnetic resonance imaging allowed for accurate diagnosis and staging of the tumors. Biopsies were not performed. Surgery represented the gold standard for treatment of juvenine nasopharyngeal angiofibroma. All patients had the tumor removed by an external approach, endoscopic surgical approach not being employed in this series of patients. RESULTS All patients were treated surgically. Surgical techniques performed were: Denker-Rouge technique in 13 cases (43.33%), paralateronasal technique in 7 cases (23.33%), retropalatine technique in 5 cases (16.66%) and transpalatine technique in 5 cases (16.66%). No preoperative tumor embolization was performed. The recurrence rate was 16.66%. The follow-up period ranged from 1 year to 12 years. CONCLUSIONS Management of juvenile nasopharyngeal angiofibroma remains a surgical challenge. Clinical evaluation and surgical experience are very important in selecting the proper approach. A multidisciplinary team, with an experienced surgeon and good collaboration with the anesthesiologist are needed for successful surgical treatment.
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Affiliation(s)
- Gheorghe Iovanescu
- Department of Otolaryngology, Victor Babes University of Medicine and Pharmacy Timisoara, Romania.
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21
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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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22
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Boghani Z, Husain Q, Kanumuri VV, Khan MN, Sangvhi S, Liu JK, Eloy JA. Juvenile nasopharyngeal angiofibroma: A Systematic Review and Comparison of Endoscopic, Endoscopic-Assisted, and Open Resection in 1047 Cases. Laryngoscope 2013; 123:859-69. [DOI: 10.1002/lary.23843] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/12/2012] [Accepted: 10/03/2012] [Indexed: 11/07/2022]
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23
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Wang JJ, Sun XC, Hu L, Liu ZF, Yu HP, Li H, Wang SY, Wang DH. Endoglin (CD105) expression on microvessel endothelial cells in juvenile nasopharyngeal angiofibroma: tissue microarray analysis and association with prognostic significance. Head Neck 2013; 35:1719-25. [PMID: 23471755 DOI: 10.1002/hed.23210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine endoglin (CD105) expression on microvessel endothelial cells (ECs) in juvenile nasopharyngeal angiofibroma (JNA) and its relationship with recurrence. METHODS Immunohistochemistry was performed to detect CD105 expression in a tissue microarray from 70 patients with JNA. Correlation between CD105 expression on microvessel ECs and clinicopathological features, as well as tumor recurrence, were analyzed. RESULTS Immunohistochemistry revealed CD105 expression on ECs but not in stroma of patients with JNA. Chi-square analysis indicated CD105-based microvessel density (MVD) was correlated with JNA recurrence (p = .013). Univariate and multivariate analyses determined that MVD was a significant predictor of time to recurrence (p = .009). The CD105-based MVD was better for predicting disease recurrence (AUROC: 0.673; p = .036) than other clinicopathological features. CONCLUSIONS MVD is a useful predictor for poor prognosis of patients with JNA after curative resection. Angiogenesis, which may play an important role in the occurrence and development of JNA, is therefore a potential therapeutic target for JNA.
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Affiliation(s)
- Jing-Jing Wang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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24
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Shahrjerdi B, Angoyaroko A, Abdullah B. Co-existing of sinonasal inverted papilloma and angiofibroma: case report and review of the literature. Acta Inform Med 2013; 20:261-3. [PMID: 23378696 PMCID: PMC3558286 DOI: 10.5455/aim.2012.20.261-263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/30/2012] [Indexed: 11/03/2022] Open
Abstract
Sinonasal tumors may grow to considerable size before presentation and in view of their relation to the base of skull, orbit, cranial nerves and vital vessels; a precise diagnostic and therapeutic planning is needed to achieve the optimal results. We report a case who presented with unilateral nasal blockage, rhinorrhea and episodes of epistaxis which diagnosed as sinonasal inverted papilloma and angiofibroma.
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Affiliation(s)
- Behzad Shahrjerdi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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25
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Arens C. Transoral treatment strategies for head and neck tumors. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc05. [PMID: 23320057 PMCID: PMC3544208 DOI: 10.3205/cto000087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed.
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Affiliation(s)
- Christoph Arens
- Clinic for Ear, Nose and Throat Medicine, University Hospital Magdeburg, Germany
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Renkonen S, Kankainen M, Hagström J, Haglund C, Monni O, Mäkitie AA. Systems-level analysis of clinically different phenotypes of juvenile nasopharyngeal angiofibromas. Laryngoscope 2012; 122:2728-35. [PMID: 22965421 DOI: 10.1002/lary.23592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/02/2012] [Accepted: 06/22/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To explore the molecular genetic background of juvenile nasopharyngeal angiofibromas and to identify biological processes and putative factors determining the different growth patterns of these tumors. STUDY DESIGN By comparing copy number and gene expression level changes of two clinically different phenotypes of juvenile nasopharyngeal angiofibromas, we aimed to find processes essential in the growth and development of these tumors. Based on the results and prior knowledge of the proteins significance for growth, we studied the expression of tyrosine kinase SYK in 27 tumor samples. METHODS Comparative genomic hybridization and gene expression analyses were performed for the two tumor samples, and protein expression of SYK was studied in 27 samples by immunohistochemical staining. RESULTS Between low- and high-stage juvenile nasopharyngeal angiofibromas, 1,245 genes showed at least a two-fold change in expression. The corresponding proteins of these transcripts were enriched in different biological processes. Protein kinase SYK was expressed in all 27 samples, and its intensity significantly correlated with tumor stage. CONCLUSIONS Because the molecular genetic background of juvenile nasopharyngeal angiofibroma is unknown, our aim was to investigate genomic alterations that could associate to low- and high-stage tumors. We were able to identify gene expression changes that relate to particular biological processes, but assessing clinically relevant molecular profiles still requires further characterization. Due to the low incidence of juvenile angiofibroma, in the future a combination of molecular profiling data from several studies would be useful in understanding the molecular background of the disease.
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Affiliation(s)
- Suvi Renkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Haartman Institute and HusLab, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
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27
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Abstract
Fibroblastic and myofibroblastic tumors in children and adolescents are a relatively common group of soft tissue proliferations that range from reactive to hamartomatous to neoplastic, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic and immunohistochemical overlap, despite significant clinical, genetic, and prognostic differences. The fibromatoses are a major subgroup, and all types of fibromatoses can occur in the 1st 2 decades of life. Intermediate and malignant fibroblastic-myofibroblastic tumors are an important group that includes variants of fibrosarcoma and other tumors with recurrent cytogenetic or molecular genetic abnormalities and low metastatic potential. Pathologic examination is enhanced by adjunct techniques, such as immunohistochemistry, cytogenetics, and molecular genetics, although morphology provides the ultimate criteria for a specific diagnosis. This article reviews the clinicopathologic features of fibroblastic and myofibroblastic tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents, the use of diagnostic adjuncts, and differential diagnoses.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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28
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Szymańska A, Szymański M, Morshed K, Czekajska-Chehab E, Szczerbo-Trojanowska M. Extranasopharyngeal angiofibroma: clinical and radiological presentation. Eur Arch Otorhinolaryngol 2012; 270:655-60. [PMID: 22584751 PMCID: PMC3560963 DOI: 10.1007/s00405-012-2041-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/24/2012] [Indexed: 11/25/2022]
Abstract
Nasopharyngeal angiofibroma (NA) is a rare, vascular tumor affecting adolescent males. Due to aggressive local growth, skull base location and risk of profound hemorrhage, NA is a challenge for surgeons. Angiofibromas have been sporadically described in extanasopharyngeal locations. We review ten cases of extranasopharyngeal angiofibroma (ENA) and discuss the incidence, clinical presentation and management of this pathology. The group consisted of 4 males and 5 females aged 8–49. There were 7 patients with nasal angiofibroma, 1 patient with laryngeal angiofibroma, 1 patient with oral angiofibroma and another patient with infratemporal fossa tumor. In patients with nasal angiofibroma most common presenting symptoms were nasal obstruction and epistaxis. Patients with laryngeal angiofibroma suffered from mild dysphagia and patients with the infratemporal fossa tumor had painless cheek swelling. In four patients with nasal tumor computed tomography (CT) demonstrated mass with strong to intermediate contrast enhancement. In one patient with nasal tumor carotid angiography demonstrated pathological vessels without intensive tumor blush. Infratemporal fossa tumor showed intensive contrast enhancement on CT and magnetic resonance imaging (MRI) scans, and abundant vascularity on angiography. Laryngeal and oral angiofibroma required no radiological imaging. Three nasal tumors were evaluated before introduction of CT to clinical practice. All patients underwent surgery. No recurrences developed. ENAs differ significantly from NAs regarding clinical and radiological presentations. They lack typical clinical and radiological features as they develop in all age groups and in females, may be less vascularised, arise from various sites and produce a variety of symptoms.
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Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954 Lublin, Poland
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29
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Girish Rao S, Sudhakara Reddy K, Sampath S. Lefort I access for Juvenile Nasopharyngeal Angiofibroma (JNA): A prospective series of 22 cases. J Craniomaxillofac Surg 2012; 40:e54-8. [DOI: 10.1016/j.jcms.2011.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 12/28/2010] [Accepted: 03/01/2011] [Indexed: 11/30/2022] Open
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30
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Gaikwad N, Sathe N, Bhatia A, Chiplunkar D, Patil M. Surgical management of juvenile nasopharyngeal angiofibroma using lateral rhinotomy: study of 80 cases. SURGICAL TECHNIQUES DEVELOPMENT 2011. [DOI: 10.4081/std.2011.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A series of 80 patients with histopathologically confirmed juvenile nasopharyngeal angiofibroma were treated surgically over a period of ten years (1995-2004). The lateral rhinotomy approach was used to expose the tumor and its extensions. Lateral rhinotomy with its extensions provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and temporal fossa. Most intracranial, extradural extensions can also be approached. There were no major operative or post-operative complications. Longterm follow up from one to ten years showed only 8 recurrences. The added advantage of this approach is that it can be combined with all the other anterior and lateral skull base approaches. The cosmetic outcome is satisfactory if nasal aesthetic subunits are taken into considerations while making the incision. The lateral rhinotomy approach is the most direct route to the body of the tumor and can be used to approach all the possible extensions of the tumor.
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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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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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Renkonen S, Häyry V, Heikkilä P, Leivo I, Haglund C, Mäkitie AA, Hagström J. Stem cell-related proteins C-KIT, C-MYC and BMI-1 in juvenile nasopharyngeal angiofibroma--do they have a role? Virchows Arch 2010; 458:189-95. [PMID: 21113618 DOI: 10.1007/s00428-010-1010-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/03/2010] [Accepted: 11/07/2010] [Indexed: 01/11/2023]
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular tumour, occurring almost exclusively in adolescent males. Histogenesis of JNA remains unclear, two optional theories proposing either fibrous or vascular tissue as the tissue of origin. Stem cell-related proteins have been discussed to possibly participate in the growth of these tumours. In our study, we reviewed retrospective clinicopathological data of 26 JNA patients. By immunohistochemistry, we investigated the cellular distribution and expression levels of stem cell-related proteins C-KIT, C-MYC and BMI-1 and their correlation with cell and vessel density of the tumour. Contrary to earlier reports, we detected C-KIT expression in addition to stromal cells also in endothelial cells. The C-KIT expression was more dominant in slit vessels than large vessels. A significant correlation was found between endothelial immunoexpression of C-KIT and cellular density of the tumour. C-MYC and BMI-1 expression was detected in stromal cells only. Due to our finding of C-KIT expression in both stromal and endothelial cells and the strong correlation between the endothelial C-KIT expression and cellular density, we suggest that, besides the stromal tissue, the vascular component might take part in the neoplastic growth of JNA.
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Affiliation(s)
- Suvi Renkonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Wu AW, Mowry SE, Vinuela F, Abemayor E, Wang MB. Bilateral vascular supply in juvenile nasopharyngeal angiofibromas. Laryngoscope 2010; 121:639-43. [DOI: 10.1002/lary.21337] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 12/21/2022]
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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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Hodges JM, McDevitt AS, El-Sayed Ali AI, Sebelik ME. Juvenile nasopharyngeal angiofibroma: current treatment modalities and future considerations. Indian J Otolaryngol Head Neck Surg 2010; 62:236-47. [PMID: 23120720 PMCID: PMC3450247 DOI: 10.1007/s12070-010-0073-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Juvenile angiofibroma (JNA) is a relatively uncommon, highly vascular and benign tumor that presents most commonly in adolescent males. Symptoms may persist from months to years and often times, these tumors are asymptomatic until they increase and encroach on critical structures. Because of technological advances both in surgery and radiology, management of JNA patients has been refined. With the advent of more sophisticated capabilities such as CT, MRI, intensity-modulated radiation therapy (IMRT), stereotactic guidance systems as well as advanced embolization techniques, these tumors can be diagnosed and managed more effectively.Patients with juvenile angiofibroma (JNA) are typically silent for years and often present with epistaxis, nasal obstruction, facial numbness, rhinorrhea, ear popping, sinusitis, cheek swelling, visual changes and headaches. In addition to these symptoms, up to one-third of patients with this condition may present with proptosis or other orbital involvement, which are late symptoms and findings.Most physicians agree that surgery is the primary treatment modality for the early-stage disease process. However, controversy arises regarding the best treatment when a patient presents with more locally advanced disease involving widespread cranial-based extension or intracranial involvement which may necessitate a combination of treatment modalities including surgery and postoperative radiation.With the advancement of endoscopic surgery, there have been a number of cases reporting the value of its use. The purpose of this review, however, will address not only endoscopic alternatives, but will discuss other treatment options as reported in the literature. Robotic surgery of the skull base for JNA is something to expect for the future.Finally, with the advent of IMRT and an image-guided robotic radiotherapy delivery system, some researchers speculate that this will result in less objections for radiation in general and certainly less reservations for the use radiotherapy in certain circumstances, i.e. patient refusal of surgery or extensive non-resectable or recurrent JNA tumors.
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Affiliation(s)
- John M. Hodges
- Division of Otolaryngology, VA Medical Center — Memphis, University of Tennessee, Department of Otolaryngology Head and Neck Surgery, Memphis, TN USA
| | | | | | - M. E. Sebelik
- Dept of Otolaryngology Head and Neck Surgery VA Medical Center, Memphis, University of Tennessee, Memphis, TN USA
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Gallia GL, Ramanathan M, Blitz AM, Reh DD. Expanded endonasal endoscopic approach for resection of a juvenile nasopharyngeal angiofibroma with skull base involvement. J Clin Neurosci 2010; 17:1423-7. [PMID: 20708935 DOI: 10.1016/j.jocn.2010.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 04/08/2010] [Indexed: 11/20/2022]
Abstract
Juvenile nasopharyngeal angiofibromas (JNAs) are rare vascular tumors which arise in the nasopharynx of adolescent males. Patients with these tumors can be cured by surgery, which is the treatment of choice in the majority of patients. Traditional surgical techniques for patients with JNAs have been via open surgical approaches. Since 2000, however, the surgical management of JNAs has changed due to advances in endoscopic procedures and such approaches are standard for early stage lesions which are limited to the nasal cavity, nasopharynx and the paranasal sinuses. The role and limitations of endoscopic approaches for JNAs with skull base and intracranial involvement are being defined. In this report, we describe a patient with a JNA with skull base involvement who underwent an expanded endonasal endoscopic approach for a complete resection. Additionally, we review the literature of endoscopic approaches to JNAs with skull base involvement.
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Affiliation(s)
- Gary L Gallia
- Department of Neurosurgery and Oncology, Johns Hopkins Hospital, Phipps Building, Room 118, Baltimore, Maryland 21287, USA.
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Effect of embolisation on endoscopic resection of angiofibroma. The Journal of Laryngology & Otology 2010; 124:631-5. [DOI: 10.1017/s0022215109992726] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:To determine the effect of embolisation on endoscopic resection of angiofibroma.Subjects and method:A partially blinded trial was undertaken. Twenty-three patients with angiofibroma (nine embolised and 14 not embolised) underwent endoscopic resection between January 2007 and August 2008 in two tertiary referral centres. Demographic data were collected, the pre-operative tumour extent was assessed by computed tomography, and tumours were staged according to their computed tomography appearance (Radkowski scale). In addition, we evaluated the duration of surgery, amount of haemorrhage, blood pressure during surgery, duration of hospitalisation, complications of surgery and embolisation, cost of treatment, and number of post-operative recurrences, as well as the angiographic characteristics in the embolisation group.Results:There was no significant difference between the general characteristics of both groups. At the end of the study period, we could find no significant difference between the two groups regarding haemorrhage, number of recurrences or complications. The only significant difference was cost of treatment, which was significantly higher in the embolisation group.Conclusion:Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolisation in every case of endoscopic angiofibroma resection.
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Abstract
There are several studies addressing regression of residual nasopharyngeal angiofibroma after surgery, but spontaneous regression of this tumor has been reported in only 2 cases. We present a case of nasopharyngeal angiofibroma that has involuted spontaneously in the last 5 years. The tumor had been diagnosed at another institute. Computed tomography taken in 2002 had revealed the tumor occupying the entire sphenoid sinus and the pterygopalatine fossa, extending to the cavernous sinus and the infratemporal fossa on the right side. The vascularization of the tumor had been mainly from the internal maxillary artery on angiography. The internal maxillary artery had been occluded with a coil, but branches of internal carotid artery could not be embolized due to high risks of complications. In 2004 the patient was seen at our institute, and this time, repeated angiography revealed rich vascularization from the internal carotid artery. The patient did not accept any treatment and was put on follow-up. He had no complaint in January 2007. The tumor was seen to disappear completely, except a little remnant at the right pterygopalatine fossa on computed tomography. This is the third reported case in the literature with spontaneous regression of nasopharyngeal angiofibroma.
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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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Budzynowska K, Pietniczka M, Dowzenko A, Borowska K, Czepiel W. [Safe extirpating of AFJ after preoperative tumor obliteration with tissue adhesive glue]. Otolaryngol Pol 2008; 62:408-11. [PMID: 18837213 DOI: 10.1016/s0030-6657(08)70281-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this work is to present the method of operating juvenile nasopharyngeal angiofibroma with the use of preoperative obliteration with tissue adhesive glue (Histoacryl). Authors described the case of 15 years old patient, who was admitted to ENT Department because of epistaxis, nasal obturation and returning headaches. To explain this problem, the routine diagnostics CT and angio-CT scan was applicated. Angiography confirmed well vascularized tumor supplied from facial and palatine arteries. Therapy based on the obliteration of tumor vessels with the glue-tissue was applied. As the next step the tumour was surgically extirpated. The application of this method gave a very good, simply bloodless operation effects. It allows a very good, simple and fully precise tumor extirpation. The extirpation of AFJ which is a highly vascularized tumor with the previous obliteration of the supplying vessels is a safe procedure and results in complete removal of the tumour.
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Affiliation(s)
- K Budzynowska
- Oddział Otolaryngologii Miedzyleskiego Szpitala Specjalistycznego w Warszawie
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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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Yiotakis I, Eleftheriadou A, Davilis D, Giotakis E, Ferekidou E, Korres S, Kandiloros D. Juvenile nasopharyngeal angiofibroma stages I and II: a comparative study of surgical approaches. Int J Pediatr Otorhinolaryngol 2008; 72:793-800. [PMID: 18387676 DOI: 10.1016/j.ijporl.2008.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 02/04/2008] [Accepted: 02/05/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to compare different surgical options used for removal of stages I and II juvenile nasopharyngeal angiofibromas (JNAs). Treatment morbidity was evaluated through blood loss, surgery duration, postoperative hospitalization and outcome. Moreover, an effort was made to explore the role and limits of endoscopic surgery. MATERIALS AND METHODS 20 male patients (mean age 14.9 years) were treated for JNA using three different surgical approaches in the Department of Otolaryngology of the University of Athens between May 1998 and January 2007. 9 patients were managed using endoscopic approach, while 5 were treated through midfacial degloving. A transpalatal approach was performed in remaining 6 patients. Preoperative angiography with embolization was performed in all 9 patients who underwent endoscopic removal and in 3 patients treated by midfacial degloving technique. RESULTS Findings demonstrated that endoscopic approach, assisted by preoperative embolization, lead to less intraoperative blood loss, shorter duration of surgical procedure, shorter length of hospital stay and no complications, compared with the conventional techniques. CONCLUSIONS Our data suggest that with proper patient selection, endoscopic resection of stages I and II JNA, when it is performed after embolization of the feeding vessels, is remarkably bloodless and precise and may be preferable to traditional open approaches.
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Affiliation(s)
- Ioannis Yiotakis
- Department of Otolaryngology, University of Athens, "Hippokration" Hospital, Athens, Greece
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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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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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Chen MK, Tsai YL, Lee KW, Chang CC. Strictly endoscopic and harmonic scalpel-assisted surgery of nasopharyngeal angiofibromas: eligible for advanced stage tumors. Acta Otolaryngol 2006; 126:1321-5. [PMID: 17101595 DOI: 10.1080/00016480600617118] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSIONS With the assistance of the harmonic scalpel, endoscopic surgery is eligible for advanced nasopharyngeal angiofibromas with skull base or infratemoporal fossa invasion. OBJECTIVES To evaluate the safety and efficacy of strictly endoscopic removal of early and advanced stage nasopharyngeal angiofibromas. Patients and methods. Eight operations for seven consecutive patients presenting with a nasopharyngeal angiofibroma were performed via minimally invasive endoscopic resection by a single surgeon (M.K.C.). All patients were operated with curative intent. RESULTS Using Radkowski staging, one, two, one, one, and three tumors were stage Ia, IIa, IIb, IIc, and IIIa lesions, respectively. All the tumors were removed successfully by strictly endoscopic surgery. No complications associated with the operation occurred. The average follow-up was 54 months. One recurrence (14.3%) occurred in this series and the salvage surgery was performed by second curative endoscopic procedure.
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Affiliation(s)
- Mu-Kuan Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhiu Christian Hospital, Changhua, Taiwan.
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Abstract
The technical skill set of peripheral interventional radiologists is well-suited to the performance of most transcatheter embolization procedures in the external carotid artery (ECA). These procedures center in large part on hypervascular tumors, epistaxis, and trauma. ECA embolization in the trauma patient is well-defined, albeit in small patient series. The transcatheter treatment of epistaxis is still mostly reserved for cases that are intractable to conservative therapy. Preoperative embolotherapy for vascular tumors remains popular, although it is somewhat controversial in terms of its risk-benefit ratio. The purpose of this review is to highlight pertinent anatomy, selected technical procedural aspects, and the available literature to better characterize the role of ECA embolization in the hands of the practicing peripheral interventionist.
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Affiliation(s)
- Tony P Smith
- Department of Radiology, Duke University Medical Center, Room 1502, Box 3808, Durham, North Carolina 27710, USA.
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Borghei P, Baradaranfar MH, Borghei SH, Sokhandon F. Transnasal Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma without Preoperative Embolization. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608501114] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular, and locally invasive tumor. Because the location of these tumors makes conventional surgery difficult, interest in endoscopic resection is increasing, particularly for the treatment of lesions that do not extend laterally into the infratemporal fossa. We report the results of our series of 23 patients with JNA (stage IIB or lower) who underwent transnasal endoscopic resection under hypotensive general anesthesia without preoperative embolization of the tumor. All tumors were successfully excised. The amount of intraoperative blood loss was acceptable. We observed only 1 recurrence, which was diagnosed 19 months postoperatively in a patient with a stage IIB primary tumor. We observed only 3 complications during follow-up—all synechia. We conclude that endoscopic resection of JNAs is safe and effective. The low incidence of recurrence and complications in this series indicates that preoperative embolization may not be necessary for lesions that have not undergone extensive spread; instead, intraoperative bleeding can be adequately controlled with good hypotensive general anesthesia.
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Affiliation(s)
- Peyman Borghei
- Ear, Nose, Throat Research Center, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Hebatodin Borghei
- Ear, Nose, Throat Research Center, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Sokhandon
- Department of Diagnostic Radiology, University of Michigan Medical Center, Ann Arbor
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Gupta R, Thomas AJ, Horowitz M. Intracranial Head and Neck Tumors: Endovascular Considerations, Present and Future. Neurosurgery 2006; 59:S251-60; discussion S3-13. [PMID: 17053610 DOI: 10.1227/01.neu.0000239249.65742.1c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
TO REVIEW THE literature on endovascular therapies available to clinicians to aid in the management of head, neck, and intracranial tumors. Hypervascular tumors of the head and neck region, as well as the intracranial region, are associated with large amounts of blood loss intraoperatively. Preoperative embolization of selected hypervascular tumors has been proposed in the literature as a method of reducing blood loss intraoperatively. This technique involves superselective catheterization of the feeding arteries to the tumor bed and then by infusion of embolic particles to saturate the tumor bed in the hopes of inducing necrosis. For less vascular tumors, selective infusion of chemotherapeutic agents has been reported as a method of reducing the systemic toxic effects of these medications. Endovascular therapies for hypervascular and less vascular tumors hold promise, although multicenter randomized controlled trials are required to help identify the patients that will benefit the most.
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Affiliation(s)
- Rishi Gupta
- Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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