Cohen-Cohen Salomon, Carlstrom Lucas P, Janus Jeffrey R, Van Gompel Jamie J
Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):E227-E228. doi: 10.1093/ons/opaa375.
Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular benign tumor that originates in the sphenopalatine foramen and often spreads to adjacent compartments.1 Microsurgical resection with preoperative embolization remains the treatment of choice.2 We present a case of a large JNA involving multiple compartments. The patient is a 20-yr-old male who presented with long-term right nasal congestion. The MRI demonstrated a large enhancing mass that extended from the right nasal cavity and nasopharynx into the right pterygopalatine fossa (PPF), infratemporal fossa (ITF), and parapharyngeal space. Preoperative angiogram for embolization showed a highly vascular tumor with blood supply mainly from the internal maxillary artery and about 10% from a persistent mandibular branch of the internal carotid artery. Based on the UPMC JNA staging system, this tumor was a stage IV.2 A combined anterior transmaxillary (Caldwell-Luc) with an endoscopic endonasal transpterygoid approach was performed. The addition of the anterior transmaxillary approach increases the surgical freedom for traditional bipolar devices and improves the view and trajectory to more lateral structures like the PPF and ITF.3 Gross total resection was achieved without complications. The patient was discharged home with a partial V2 numbness (right superior gum) that improved with time. The endoscopic endonasal approach is a safe and effective technique even for large JNA. A multidisciplinary team consisting of an interventional radiologist, a skull base neurosurgeon, and an otorhinolaryngologist with expertise in endoscopic surgery may play a role for optimal surgical results. The patient consented for the procedure and for the video production.
青少年鼻咽血管纤维瘤（JNA）是一种血管丰富的良性肿瘤，起源于蝶腭孔，常蔓延至相邻间隙。1术前栓塞的显微手术切除仍是首选治疗方法。2我们报告一例累及多个间隙的大型JNA病例。患者为一名20岁男性，长期右侧鼻塞。MRI显示一个大的强化肿块，从右侧鼻腔和鼻咽延伸至右侧翼腭窝（PPF）、颞下窝（ITF）和咽旁间隙。术前用于栓塞的血管造影显示肿瘤血管丰富，血供主要来自上颌内动脉，约10%来自颈内动脉的持续下颌分支。根据UPMC JNA分期系统，该肿瘤为IV期。2采用联合经上颌前部（Caldwell-Luc）和内镜鼻内经翼突入路。增加经上颌前部入路增加了传统双极设备的手术操作空间，并改善了对更外侧结构如PPF和ITF的视野和手术路径。3实现了肿瘤全切，无并发症。患者出院时右侧V2部分麻木（右上牙龈），随时间推移有所改善。内镜鼻内入路即使对于大型JNA也是一种安全有效的技术。由介入放射科医生、颅底神经外科医生和擅长内镜手术的耳鼻喉科医生组成的多学科团队可能有助于获得最佳手术效果。患者同意进行该手术及视频制作。
