xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.23262, Wiley Online Library on [02/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

160

KUANetal.

TABLE XVII.A.3 Evidence surrounding staging systems of JNA.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

NSF-COR staging system correlated with need for blood transfusion, recurrence rates, and resectability; correlated significantly with other staging systems

1. Blood

Abdelwahab et al. 773

2019 4

Retrospective cohort

Patients with JNA treated with

transfusion volume

endoscopic surgery; validation of a new staging system incorporating nose/nasopharynx, sinus, fossae, cranium, orbit, and residual ICA vascularity (NSF-COR) ( n = 54)

2. Recurrence 3. Resectability

Snyderman et al. 790

2010 4

Retrospective case series

Patients undergoing endoscopic

1. Presence of ICA residual vascularity 2. Intraoperative blood loss

Residual vascularity correlated significantly with blood loss and residual/recurrent tumor

resection of JNA; all patients had ECA

embolization preoperatively ( n = 35)

Abbreviations: ECA, external carotid artery; JNA, nasopharyngeal angiofibroma (formerly juvenile nasopharyngeal angiofibroma); ICA, internal carotid artery.

mitigate the risk to key neurovascular structures, creating the possibility of intentional residual disease. GTR of JNA, regardless of approach or stage, has been reported to range from 72% to 100%. 779,780 Studies have demonstrated that a considerable proportion of patients who have residual disease identified on follow-up imaging demonstrate stable disease or even disease regression on serial imaging, ranging from 67% to 83%. 792 When disease progression is identified on serial imaging, these stud ies demonstrated a growth rate ranging from 2.2 to 9.2 mm/year. 791,793 In a study by Rowan et al., all patients with residual disease had a UPMC Staging Score of V L (advanced disease with residual ICA contribution postem bolization and lateral extension), and the most common site of residual disease was the infratemporal fossa. 793 In a series of 131 patients, Liu et al. reported that fol lowing endoscopic or combined resection, the pterygoid process (76%), pterygopalatine foramen (71%), and ptery goid canal (83.3%) were the most common sites involved by recurrent tumor. 794 Reyes et al. performed a meta-analysis of nine studies and 362 patients and found an overall recur rence rate of 24.5% with a mean duration of follow-up of 49.4 months. 351 In patients without intracranial spread, endoscopic approach to removal had statistically signifi cantly lower rates of recurrence than patients who had surgery via an open approach. 351 Low-stage disease had significantly lower recurrence rates than patients with advanced disease (Radkowski Ia–IIb 18% vs. Radkowski IIc–IIIb 42%). 351 Pamuk et al. found a 20.8% rate of recur

rence in a 48-patient cohort and a significant difference in recurrence rate between patients younger than 14 (34.7%) and patients older than 14 (8%) over a mean duration of follow-up of 23.3 months (range 6–120 months). 768 Surgical approach, patient age, extent of tumor, manage ment of the pterygoid canal, and residual vascularity can help guide surgeons in predicting risk of residual tumor and location of recurrent/persistent disease following surgery for JNA (Table XVII.A.4). Aggregate grade of evidence : C (Level 2: 1 study; Level 4: six studies) 4 Trigeminal function Trigeminal dysfunction can be seen preoperatively (due to tumor involvement of CN V 2 or V 3 frequently mani fested as reduced sensation) or postoperatively as a result of iatrogenic injury or sacrifice of the nerves during the approach or tumor resection. Previous work has demon strated a 2% (12/699) rate of postoperative trigeminal dysfunction, most commonly involving the infraorbital nerve, in patients who underwent endoscopic resection of early-stage JNA. 5,777 Sacrifice of the descending pala tine nerve is rarely documented. This rate was concluded to be favorable when compared to open, craniofacial approaches, though no direct comparison of postoperative trigeminal dysfunction or cranial neuropathies has been performed.