Combined Approach for Excision of Advanced Angiofibroma : A Study of 12 Cases
Keywords:
Angiofibroma,, combined skull base approach, advanced angiofibromaAbstract
To determine effectiveness of combined skull base approach for excision of advanced angiofibroma.
Materials and Methods: This study was conducted at the Department of Ear, Nose, Throat, Head and Neck Surgery and Neurosurgery, Post Graduate Medical Institute Lady Reading Hospital Peshawar. This was retrospective observational study. The duration of the study was 5 years from Jan., 2003 to Dec., 2008. This study included 12 cases with advanced (stage IIIA and IVB) of Nasopharyngeal angiofibroma. These cases were assessed in terms of detailed history, through examination and radiological investigations to stage according to the Fisch classification. The tumour was completely excised by combined approach of a team of Neurosurgeons and ENT surgeons. No recurrence found in 30 months post-op observation.
Results: This study included 12 cases. All were male. Age of the patients was in range of 14 to 19 years with mean of 16.5 years. They belonged to lower and middle class of society. They presented with history of unilateral nasal obstruction (100%) while MRI where needed. The disease was involving nose, nasopharynx, sinuses and had Extracranial and intracranial extension. Nine cases (75%) were in stage IIIB and 3 cases (25%) in stage IVA according Fisch classification. The procedure time was average 7.5 hours and average 700 ml blood was transfused. Platal fistula formed in one case (8.3%) and no recurrence found on 18 months follow up.
Conclusion: The cooperation of neurosurgeons and otorhinolaryngological doctors provides a good way to minimize invasiveness in skull base surgery. Sufficient preoperative preparation, well equipped theatre and surgical expertise are necessary for complete resection of benign tumor like angiofibroma.
References
2. Windfuhr JP, Remmert S. Extranasopharyngeal angio-fibroma : etiology, incidence and management. Acta Oto-laryngologica, 2004; 124: 880-9.
3. Sivanandan R, Fee JR WE. Benign and malignant tumors of the nasopharynx. In : Cummings CW, Flint PW, Harker LA, et al, editors. Cummings otolaryngo-logy head and neck surgery. 4th ed. New York : Else-vier, Mosby; 2005: P. 1559-972.
4. Batsakis JG. Vasoformative tumors. In : Batsakis JG, editor. Tumors of the head and neck clinical and patho-logical considerations. 2nd ed. Baltomore : Williams and Wilkins, London Publ; 1999: P. 773-7.
5. Mistry RC, Qureshi SS, Gupta S, Gupta S. Juvenile nasopharyngeal angiofibroma : A single institution study. Indian J Cancer 2005; 42: 35-9.
6. Breme JW, Neel HB III, De Santo LW, et al. Angiofib-roma : Treatment trends in 150 patients during 40 years. Laryngoscope 1986; 96: 1321-1329.
7. Pradhan B and Thapa N. Juvenile angiofibroma and its management. Nepal Med Coll J 2009; 11 (3): 186-188.
8. Ahmed Z, Mutiullah S, Rahim D and Marfani MS. Juvenile Nasopharyngeal Angiofibroma : Stage and Surgical Approach. JLUMHS 2009; 8: 37-40.
9. Gohar MS, Rashid D and Ahmed B. Common present-ing symptoms diagnosis and management of angiofib-roma – A study of twenty cases. Pak J Med Sci 2004; 20: 377-80.
10. Enepekides DJ. Recent advances in the treatment of juvenile angiofibroma. Curr Opin Otolaryngol Head Neck Surg. 2004; 12: 495-499.
11. Scholtz AW, Appenroth E, Jolly KK, Scholtz LU, Thu-mfart WF. Juvenile Nasopharyngeal Angiofibroma : Management and Therapy. The Laryngoscope 2001; 11: 681-7.
12. Margalit N, Wasserzug O, Row AD, Abergel A, Fliss DM and Gil Z. Surgical treatment of juvenile nasopha-ryngeal angiofibroma with intracranial extension. Jour-nal of Neurosurgery Pediatrics 2009; 4: 113-17.
13. Mann WJ, Jecker P, Amedee RG. Juvenile angiofibro-mas : changing surgical concept over the last 20 years. Laryngoscope, 2004; 114: 291-293.
14. FU Ji-di, LIU Hao-cheng, ZHAO Shang-feng, ZHANG Jia-liang, LI Yong, NI Xin, YU Chun-jiang. Cranio-tomy with endoscopic assistance in the treatment of nasopharyngeal fibroangioma. Chinese Medical Journal 2010; 123: 1289-94.15. Umar AE, Ragab A and Sharnoby MM. Surgical resec-tion of type III juvenile angiofibroma without preope-rative embolization. International Journal of Pediatric Otorhinolaryngology 2006; 70: 1715-1723. 16. Tyagi I, Syal R, Goyal A. Staging and surgical appro-aches in large juvenile angiofibroma Study of 95 cases. International Journal of Pediatric Otorhinolaryngology 2006; 70: 1619-27. 17. Howard DJ, Lioyd G, Lund V. Recurrence and its avoi-dance in Juvenile Angiofibroma. Laryngoscope, 2001; 111: 1509-11. 18. Wang YF, Lin CZ. Nasopharyngeal Angiofibroma. Chinese Medical Journal (Taipei) 2001; 64: 39-46. 19. Cristina B, Mark K, Laurie A. L, Mouwafak A R, Gre-gory W, Robert H et al. Craniofacial Resection of Adv-anced Juvenile Nasopharyngeal Angiofibroma. Arch Otolaryngol Head Neck Surg. 2002; 128: 1071-1078. 20. Alamgir MA, Malakar M, Rabbani SMG, Yasmeen N, Islam S. Extensive nasopharyngeal angiofibroma – case report. Bangladesh J Otorhinolaryngol 2009; 15 (2): 75-77. 21. Ardehali MM, Ardestani SHS, Yazdani N, Goodarzi H, Shahin B. Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma : complications and out-comes. American Journal of Otolaryngology – Head and Neck Medicine and Surgery 2009; 2: 1-7. 22. Angelito JU, Hardillo, Velden IV and Knegt PP. Den-ker operation is an effective surgical approach in mana-ging juvenile nasopharyngeal angiofibroma. Ann Otol Rhinol Laryngol 2004; 113: 946-950. 23. Naraghi M, Kashfi A. Endoscopic resection of nasopha-ryngeal angiofibromas by combined transnasal and transoral. Am J Otolaryngol, 2003; 24: 149-54. 24. Koshy S, George M, Gupta A, Daniel RT. Extended osteoplastic maxillotomy for total excision of giant multicompartmental juvenile nasopharyngeal angiofib-roma. Indian J Dent Res 2008; 19: 366-9. 25. Midillli R, Karci B, Akyildiz. Juvenile nasopharyngeal angiofibroma : Analysis of 42 cases and important asp-ects of endoscopic approach, 2009; 73: 401-8.
26. Mona Thornton, Bangalore N. Mahesh, John Lang. Journal of Laparoendoscopic and Advanced Surgical Techniques 2005; 15: 194-196.
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