Resection Of Nasopharyngeal Angiofibroma Research Articles

Preoperative Embolization for Nasopharyngeal Angiofibroma: A Meta-Analysis of Blood Loss Reduction

Juvenile nasopharyngeal angiofibroma is a benign hypervascular tumor. Although histologically benign, they behave in a locally invasive manner having a propensity to thin and erode bone and displace adjacent structures. Accurate staging, preoperative embolization, and newer surgical approaches like endoscopic excision for limited stage disease and maxillary swing approach for advanced stage disease are associated with better surgical outcome. Objective: To determine the preoperative mean blood loss during resection in patients undergoing preoperative embolization of nasopharyngeal angiofibroma. Study Design: Descriptive cross-sectional survey Setting: Post graduate Medical Institute/ Ameer ud Din Medical college/Department of diagnostic and interventional neuroradiology, Lahore General Hospital, Lahore. Duration of study with dates: Study was carried out over a period of six months from 16-08- 2020to 15-02-2021. Subjects and methods: A total of 30 patients were included in this study. Peroperative blood loss was measured during resection of nasopharyngeal angiofibroma after embolization (as per operational definitions). Results: Mean age of the patients was 14.40±5.69 years. Out of 30 patients, 28 (93.3%) were males while only 2 patients (6.7%) were females. Size of tumour < 5 cm was found in 16 patients (53.3%) while >5 cm was seen in 14 patients (46.7%). Mean size of tumor was observed 5.50±2.28 and mean amount of per-operative bleeding was 596.67±204.23ml. Stratification with regard to age, gender, FNA size (cm) was also carried out. Conclusion: In conclusion, pre-operative embolization reduces significantly the preoperative blood loss, minimizes the need of blood transfusion, and makes resection easier. Keywords: Pre-surgical Embolization, Juvenile Nasopharyngeal angiofibroma, Blood loss

Analysis of factors in successful nasal endoscopic resection of nasopharyngeal angiofibroma

Conclusions: Endoscopic resection of nasopharyngeal angiofibroma is less traumatic, causes less bleeding, and provides a good curative effect. Using pre-operative embolization and controlled hypotension, reasonable surgical strategies and techniques lead to successful resection tumors of a maximum Andrews-Fisch classification stage of III. Objective: To investigate surgical indications, methods, surgical technique, and curative effects of transnasal endoscopic resection of nasopharyngeal angiofibroma, this study evaluated factors that improve diagnosis and treatment, prevent large intra-operative blood loss and residual tumor, and increase the cure rate. Methods: A retrospective analysis was performed of the clinical data and treatment programs of 23 patients with nasopharyngeal angiofibroma who underwent endoscopic resection with pre-operative embolization and controlled hypotension. The surgical method applied was based on the size of tumor and extent of invasion. Curative effects were observed. Results: No intra-operative or perioperative complications were observed in 22 patients. Upon removal of nasal packing material 3–7 days post-operatively, one patient experienced heavy bleeding of the nasopharyngeal wound, which was treated compression hemostasis using post-nasal packing. Twenty-three patients were followed up for 6–60 months. Twenty-two patients experienced cure; one patient experienced recurrence 10 months post-operatively, and repeat nasal endoscopic surgery was performed and resulted in cure.

Endoscopic transnasal approach for nasopharyngeal angiofibroma without arterial embolism

To explore the feasibility of endoscopic resection without arterial embolism for nasopharyngeal angiofibroma and the strategy of decreasing the bleeding during the operation. The clinical data of twenty-five cases of nasopharyngeal angiofibroma were retrospective analyzed, including 3 cases of Radowski stageIIa, 5 cases of stageIIb, 4 cases of stageIIc and with 13 cases of stage IIIa. All cases did not receive the arterial embolism, and controlled hypotension were adopted under endoscopic transnasal approach during the tumor resection. Two cases were added the labiogingival incision. During the operation, under the opening vision, cutting out the outside of the infratemporal fossa, and the pterygoid process to adequate exposure the pterygopalatine fossa and infratemporal fossa.Early recognition of anatomical landmarks and establish the safety plane, along the periphery of the tumor to proceed with micro-separation, early blocking tumor nutrient vessels, en bloc resection of the tumor and some other ways to reduce bleeding and tumor resection. Amount of bleeding during operation was 600-1500 ml, none of them had internal carotid artery injury and intracranial injury or some other complication.Follow-up 2-3 years was available in all patients, except 1 case with residual of tumor surrounding the optic nerve, the other 24 cases had no residual tumor and relapses. The preoperative occlusion and artery ligation may not be needed.Surgical technique is the key to reduce blood loss, and it is feasible to have endoscopic resection of nasopharyngeal angiofibroma with proper operating technique.