Szymańska Anna, Szymański Marcin, Czekajska-Chehab Elżbieta, Szczerbo-Trojanowska Małgorzata
Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8, 20-954, Lublin, Poland,
Eur Arch Otorhinolaryngol. 2015 Jan;272(1):159-66. doi: 10.1007/s00405-014-2965-y. Epub 2014 Mar 6.
Juvenile nasopharyngeal angiofibroma is a benign, locally aggressive nasopharyngeal tumor. Apart from anterior lateral extension to the pterygopalatine fossa, it may spread laterally posterior to the pterygoid process, showing posterior lateral growth pattern, which is less common and more difficult to identify during surgery. We analyzed the routes of lateral spread, modalities useful in its diagnosis, the incidence of lateral extension and its influence on outcomes of surgical treatment. The records of 37 patients with laterally extending JNA treated at our institution between 1987 and 2011 were retrospectively evaluated. Computed tomography was performed in all patients and magnetic resonance imaging in 17 (46 %) patients. CT and MRI were evaluated to determine routes and extension of JNA lateral spread. Anterior lateral extension to the pterygopalatine fossa occurred in 36 (97 %) patients and further to the infratemporal fossa in 20 (54 %) patients. In 16 (43 %) cases posterior lateral spread was observed: posterior to the pterygoid process and/or between its plates. The recurrence rate was 29.7 % (11/37). The majority of residual lesions was located behind the pterygoid process (7/11). Recurrent disease occurred in 3/21 patients with anterior lateral extension, in 7/15 patients with both types of lateral extensions and in 1 patient with posterior lateral extension. JNA posterior lateral extension may spread behind the pterygoid process or between its plates. The recurrence rate in patients with anterior and/or posterior lateral extension is significantly higher than in patients with anterior lateral extension only. Both CT and MRI allow identification of the anterior and posterior lateral extensions.
青少年鼻咽血管纤维瘤是一种良性但具有局部侵袭性的鼻咽肿瘤。除了向前外侧延伸至翼腭窝外，它还可能向翼突后方外侧扩散，呈现后外侧生长模式，这种情况较少见且在手术中更难识别。我们分析了其外侧扩散途径、有助于诊断的方式、外侧延伸的发生率及其对手术治疗结果的影响。回顾性评估了1987年至2011年在我们机构接受治疗的37例外侧延伸型青少年鼻咽血管纤维瘤患者的记录。所有患者均进行了计算机断层扫描，17例（46%）患者进行了磁共振成像。对CT和MRI进行评估以确定青少年鼻咽血管纤维瘤外侧扩散的途径和范围。36例（97%）患者出现向前外侧延伸至翼腭窝，20例（54%）患者进一步延伸至颞下窝。16例（43%）病例观察到后外侧扩散：在翼突后方和/或其板之间。复发率为29.7%（11/37）。大多数残留病变位于翼突后方（7/11）。21例向前外侧延伸的患者中有3例复发，15例两种类型外侧延伸的患者中有7例复发，1例后外侧延伸的患者复发。青少年鼻咽血管纤维瘤后外侧延伸可能扩散至翼突后方或其板之间。有前外侧和/或后外侧延伸的患者的复发率明显高于仅向前外侧延伸的患者。CT和MRI均能识别前外侧和后外侧延伸。
