Abstract
Background. Surgical approaches to the parapharyngeal space (PPS) are challenging by virtue of deep location and neurovascular content. Juvenile Nasopharyngeal Angiofibroma (JNA) is a formidable hypervascular tumor that involves multiple compartments with increase in size. In tumors with extension to parapharyngeal space, the endonasal approach was observed to be inadequate. Combined Endoscopic Endonasal Approaches and Endoscopic Transoral Surgery (EEA-ETOS) approach has provided a customized alternative of multicorridor approach to access JNA for its safe and efficient resection. Methods. The study demonstrates a case series of patients of JNA with prestyloid parapharyngeal space extension operated by endoscopic endonasal and endoscopic transoral approach for tumor excision. Results. The multiport EEA-ETOS approach was used to provide wide exposure to access JNA in parapharyngeal space. No major complications were observed. No conversion to external approach was required. Postoperative morbidity was low and postoperative scans showed no residual tumor. A one-year follow-up was maintained and there was no evidence of disease recurrence. Conclusion. Although preliminary, our experience demonstrates safety and efficacy of multiport approach in providing access to multiple compartments, facilitating total excision of JNA in selected cases.
Highlights
Juvenile Nasopharyngeal Angiofibroma (JNA) is a hypervascular benign neoplasm known for its peculiar local aggressive spread along the pathways of least resistance
In this study we present our experience of two cases of JNA with prestyloid parapharyngeal space involvement, surgically managed by an alternative approach to the parapharyngeal space, a combined endoscopic endonasal approach (EEA), and endoscopic transoral approach (ETOS) ensuring complete resection
The advent of endoscopic approaches for the skull base has paved the way for minimally invasive surgeries in complex lesions
Summary
JNA is a hypervascular benign neoplasm known for its peculiar local aggressive spread along the pathways of least resistance This tumor is of considerable scientific interest due to its vascularity and high incidence of recurrence. Principles for successful total endoscopic resection of JNA have evolved over the years allowing authors to consider endoscopy as the choice of approach for advanced tumors. In tumors with extension to parapharyngeal space, the endonasal approach was observed to be inadequate. The study demonstrates a case series of patients of JNA with prestyloid parapharyngeal space extension operated by endoscopic endonasal and endoscopic transoral approach for tumor excision. The multiport EEA-ETOS approach was used to provide wide exposure to access JNA in parapharyngeal space. Our experience demonstrates safety and efficacy of multiport approach in providing access to multiple compartments, facilitating total excision of JNA in selected cases
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