2nd Academic Department of Otorhinolaryngology Head and Neck Surgery, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki Ring Road, Nea Efkarpia, 56429, Thessaloniki, Greece.
Eur Arch Otorhinolaryngol. 2012 Feb;269(2):523-9. doi: 10.1007/s00405-011-1708-6. Epub 2011 Jul 26.
The endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) emerges as an alternative approach to open procedures due to reduced morbidity and comparable recurrence rates. The purpose of this study was to present our experience with the endoscopic management of JNA using retrospective chart review of ten male patients (mean age 15.7 years) with JNA who were treated endoscopically at our institution between the years 2003 and 2010. According to the Radkowski's system, one patient was at stage Ia, two at stage Ib, one at stage IIa, two at stage IIb, two at stage IIc (infratemporal fossa invasion) and two at stage IIIa (clivus erosion). Six patients underwent preoperative embolization. The endoscopic treatment involved total ethmoidectomy, middle meatal antrostomy, sphenoidotomy, clipping of the sphenopalatine artery and its branches and drilling of the pterygoid basis. All patients underwent magnetic resonance imaging 3 months postoperatively and then if indicated clinically. Mean follow-up was 23.7 months (range 3-70). All but one patient were free of macroscopic disease. A patient with stage IIb JNA developed a recurrence after 9 months. The residual tumor was resected endoscopically and the sphenopalatine foramen widened by drilling. The patient is free of disease 25 months postoperatively. The intra-operative blood loss was not excessive (200-800 ml, mean: 444 ml) and no patient required a blood transfusion. Patients were discharged after 4-8 days (mean 5 days). One patient developed postoperative infraorbital nerve hypoesthesia. Results showed that endoscopic treatment of stage I and IIa/b JNA is a valid alternative to external approaches. For select tumors with limited infratemporal fossa invasion and skull base erosion, the endoscopic approach may also be indicated. It is a safe and effective treatment modality due to the lack of external scars, minimal bone resection and blood loss and low recurrence rate.
青少年鼻咽血管纤维瘤（JNA）的内镜切除术由于发病率降低和可比较的复发率而成为开放手术的替代方法。本研究的目的是通过回顾性分析 2003 年至 2010 年间在我们机构接受内镜治疗的 10 例男性 JNA 患者（平均年龄 15.7 岁）的图表，介绍我们在内镜治疗 JNA 方面的经验。根据 Radkowski 系统，1 例患者为 Ia 期，2 例为 Ib 期，1 例为 IIa 期，2 例为 IIb 期，2 例为 IIc 期（颞下窝侵犯），2 例为 IIIa 期（斜坡侵蚀）。6 例患者行术前栓塞。内镜治疗包括全筛窦切除术、中鼻道切开术、蝶窦切开术、翼腭动脉及其分支夹闭和翼突基底部钻孔。所有患者术后 3 个月行磁共振成像检查，然后根据临床需要进行检查。平均随访时间为 23.7 个月（3-70 个月）。除 1 例患者外，所有患者均无肉眼可见疾病。1 例 IIb 期 JNA 患者 9 个月后复发。残留肿瘤经内镜切除，翼腭孔扩大。术后 25 个月患者无疾病。术中出血量不大（200-800ml，平均：444ml），无患者需要输血。患者术后 4-8 天（平均 5 天）出院。1 例患者术后出现眶下神经感觉减退。结果表明，内镜治疗 I 期和 IIa/b 期 JNA 是对外科方法的有效替代。对于侵犯范围有限的颞下窝和颅底侵蚀的选择肿瘤，也可以采用内镜治疗。由于没有外部疤痕、最小的骨切除和出血以及低复发率，该方法是一种安全有效的治疗方式。
