Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
Loma Linda University School of Medicine, Loma Linda, California, USA.
Head Neck. 2021 Feb;43(2):719-724. doi: 10.1002/hed.26516. Epub 2020 Oct 28.
Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular and benign tumors that can expand into the skull base. Delay of treatment can result in intracranial invasion, requiring extensive open approaches such as a facial translocation, maxillary swing, or an orbitozygomatic craniotomy. We describe a single-stage, combined endoscopic and transoral approach on a 14-year-old male with extensive high-stage dumbbell-shaped JNA involving the infratemporal fossa, orbit, buccal space, and intracranial extension into Meckel's cave. Successful resection of the tumor and good postoperative outcome was achieved. A transoral approach allowed for greater access to the infratemporal fossa, where endonasal resection was not possible, allowing for improved visualization, greater traction, and dissection. In select highly staged JNAs with significant lateral extension and intracranial involvement, successful and complete resection may be accomplished with this combined approach. Utilization of this approach avoids the morbidity of more invasive open approaches.
青少年鼻咽血管纤维瘤（JNAs）是高度血管化的良性肿瘤，可扩展至颅底。延迟治疗可能导致颅内侵犯，需要广泛的开放性手术，如面部移位、上颌摆动或眶颧开颅术。我们描述了一种单一阶段的内镜和经口联合入路，用于治疗 14 岁男性的广泛高分期哑铃形 JNA，涉及颞下窝、眼眶、颊间隙和颅内延伸至 Meckel 氏腔。成功切除肿瘤，术后效果良好。经口入路可更好地进入颞下窝，而经鼻切除无法到达此处，从而可改善可视化效果、更好地牵引和分离。在选择具有显著外侧扩展和颅内受累的高度分期 JNAs 中，这种联合方法可成功完成完全切除。这种方法的应用可避免更具侵袭性的开放性方法带来的发病率。
