Archives of otolaryngology--head & neck surgery · 2010
A new endoscopic staging system for angiofibromas.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Snyderman Carl H, Pant Harshita, Carrau Ricardo L, Gardner Paul
Аннотация
OBJECTIVE: To develop a new staging system for juvenile nasopharyngeal angiofibroma that reflects changes in surgical approaches (endonasal), route of intracranial extension, and the extent of vascular supply from the internal carotid artery.
DESIGN: Retrospective review of case series.
SETTING: Academic medical center.
PATIENTS: Patients undergoing endoscopic endonasal surgery for juvenile nasopharyngeal angiofibroma at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, from 1998 through 2008.
INTERVENTION: Patients were staged according to current systems and compared with a new staging system that also incorporated the route of skull base extension and tumor vascularity.
MAIN OUTCOME MEASURES: Estimated blood loss, number of operations, and tumor recurrence.
RESULTS: Skull base erosion was observed in 74% of cases. Following embolization of external carotid artery tributaries, residual vascularity from the internal carotid artery was seen in 51% of patients. Residual vascularity, classified as UPMC stage IV and V, strongly correlated with blood loss, requirement for multiple procedures, and residual or recurrent tumor.
CONCLUSIONS: Tumor size and extent of sinus disease are less important in predicting complete tumor removal with endonasal surgical techniques. The UPMC staging system for juvenile nasopharyngeal angiofibroma accounts for 2 important prognostic factors, route of cranial base extension, and vascularity and is applicable to endoscopic or open approaches. Compared with other staging systems, the UPMC staging system provides a better prediction of immediate morbidity (including blood loss and need for multiple operations) and tumor recurrence.
DESIGN: Retrospective review of case series.
SETTING: Academic medical center.
PATIENTS: Patients undergoing endoscopic endonasal surgery for juvenile nasopharyngeal angiofibroma at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, from 1998 through 2008.
INTERVENTION: Patients were staged according to current systems and compared with a new staging system that also incorporated the route of skull base extension and tumor vascularity.
MAIN OUTCOME MEASURES: Estimated blood loss, number of operations, and tumor recurrence.
RESULTS: Skull base erosion was observed in 74% of cases. Following embolization of external carotid artery tributaries, residual vascularity from the internal carotid artery was seen in 51% of patients. Residual vascularity, classified as UPMC stage IV and V, strongly correlated with blood loss, requirement for multiple procedures, and residual or recurrent tumor.
CONCLUSIONS: Tumor size and extent of sinus disease are less important in predicting complete tumor removal with endonasal surgical techniques. The UPMC staging system for juvenile nasopharyngeal angiofibroma accounts for 2 important prognostic factors, route of cranial base extension, and vascularity and is applicable to endoscopic or open approaches. Compared with other staging systems, the UPMC staging system provides a better prediction of immediate morbidity (including blood loss and need for multiple operations) and tumor recurrence.