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Combined endoscopic endonasal and sublabial transmaxillary approaches for resection of intracranially extended juvenile nasopharyngeal angiofibroma

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Abstract

Background

Juvenile nasopharyngeal angiofibromas (JNAs) are rare, benign, and locally invasive nasopharyngeal tumors. Endoscopic endonasal resection is effective, non-invasive, with low complication rates. Until recently, endoscopic resection was not suitable for intracranially invasive tumors.

Purpose/Method

We describe resection steps of an intracranially extending JNA with a combined endoscopic endonasal and endoscopic-assisted sublabial transmaxillary approaches. Indications, advantages, and approach-specific complications are also discussed. The main surgical steps are shown in an operative video.

Conclusion

Surgical excision of JNAs by a combined endoscopic endonasal and sublabial transmaxillary approaches represents a safe and effective treatment for selected intracranially invasive JNA.

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Acknowledgements

Joseph I. and Barbara Ashkins Endowed Professorship in surgery

Funding

This work was supported in part by Joseph I. and Barbara Ashkins Endowed Professorship in surgery.

Author information

Authors and Affiliations

  1. Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA

    Camryn Marshall

  2. Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA

    Edoardo Agosti, Maria Peris-Celda & Carlos D. Pinheiro-Neto

  3. Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA

    Edoardo Agosti, Maria Peris-Celda & Carlos D. Pinheiro-Neto

  4. Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Maria Peris-Celda & Carlos D. Pinheiro-Neto

Authors
  1. Camryn Marshall
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  2. Edoardo Agosti
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  3. Maria Peris-Celda
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  4. Carlos D. Pinheiro-Neto
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Corresponding author

Correspondence to Carlos D. Pinheiro-Neto.

Ethics declarations

Ethics approval

Approval was obtained from the ethics committee of the Mayo Clinic. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all participants included in this study.

Conflict of interest

The authors declare no competing interests.

Additional information

Key Points

1. JNAs represent 0.5% of all head and neck tumors;

2. JNAs are benign lesions and primarily occur in adolescent males;

3. Preoperative embolization is important to reduce the intraoperative bleeding and achieve gross total resection;

4. Avoid upfront tumor debulking;

5. Proceed with ethmoidectomy and sphenoidotomy applying gentle pressure to the tumor;

6. Separation of tumor attachments from surrounding structures helps with its devascularization;

7. Divide the tumor with ultrasonic scalpel in anatomical compartments;

8. Orbital decompression allows exposure of the SOF;

9. Drilling of the pterygoid base is required to ensure complete tumor resection;

10. Consider adding other approaches if ICA encasement or control of the parapharyngeal ICA is desired.

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Camryn Marshall and Edoardo Agosti are co-first authors.

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Marshall, C., Agosti, E., Peris-Celda, M. et al. Combined endoscopic endonasal and sublabial transmaxillary approaches for resection of intracranially extended juvenile nasopharyngeal angiofibroma. Acta Neurochir 165, 1773–1780 (2023). https://doi.org/10.1007/s00701-023-05634-2

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  • DOI: https://doi.org/10.1007/s00701-023-05634-2

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