Fagan J J, Snyderman C H, Carrau R L, Janecka I P
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Head Neck. 1997 Aug;19(5):391-9. doi: 10.1002/(sici)1097-0347(199708)19:5<391::aid-hed5>3.0.co;2-v.
A review of 16 juvenile nasopharyngeal angiofibromas, managed at the University of Pittsburgh, is presented.
A retrospective chart review was done. Surgical approaches and factors affecting recurrence are analyzed.
Endoscopic transnasal, transpalatal, medial maxillectomy, facial translocation, and infratemporal fossa approaches, with or without craniotomy, were employed. The 37.5% recurrence rate reflects the advanced stage of the tumors. A major risk factor for recurrence was tumor involvement of the cranial base.
The surgical approach should be selected according to tumor location and effectiveness of embolization. In young patients, the approach should minimize the potential for facial growth retardation. Tumors confined to the nasopharynx, nasal cavity, and paranasal sinuses may be removed endoscopically. Medial maxillectomy is recommended for tumors that extend to the medial intratemporal fossa or medial cavernous sinus. Significant involvement of the infratemporal fossa, cavernous sinus, or middle cranial fossa requires infratemporal fossa or transfacial approaches.
本文介绍了匹兹堡大学对16例青少年鼻咽血管纤维瘤的治疗情况。
进行回顾性病历审查。分析手术方法及影响复发的因素。
采用了经鼻内镜、经腭、上颌骨内侧切除术、面部移位术和颞下窝入路，有或无开颅手术。37.5%的复发率反映了肿瘤的晚期阶段。复发的一个主要危险因素是颅底受肿瘤侵犯。
应根据肿瘤位置和栓塞效果选择手术入路。对于年轻患者，该入路应尽量减少面部生长发育迟缓的可能性。局限于鼻咽、鼻腔和鼻窦的肿瘤可通过内镜切除。对于延伸至颞下窝内侧或海绵窦内侧的肿瘤，建议行上颌骨内侧切除术。颞下窝、海绵窦或中颅窝有明显受累时，需要采用颞下窝或经面部入路。
