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An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension

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机构: [1]Capital Med Univ, Beijing Tongren Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China [2]Ohio State Univ, Dept Otolaryngol Head & Neck Surg, James Canc Ctr, Wexner Med Ctr, Starling Loving Hall,Room B221,614-685-6778, Columbus, OH 43210 USA [3]Johns Hopkins Sch Med, Dept Otolaryngol Head & Neck Surg, Baltimore, MD USA [4]Ohio State Univ, Dept Neurol Surg, James Canc Hosp, Wexner Med Ctr, Columbus, OH 43210 USA
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关键词: nasopharyngectomy fossa of Rosenmuller jugular foramen petroclival region expanded endonasal approach

摘要:
Background Invasion depth influences the choice for extirpation of nasopharyngeal malignancies. This study aims to validate the feasibility of endoscopic endonasal resection of lesions with a posterolateral invasion. As a secondary goal, the study intends to propose a classification system of endoscopic endonasal nasopharyngectomy determined by the depth of posterolateral invasion. Methods Eight cadaveric specimens (16 sides) underwent progressive nasopharyngectomy using an endoscopic endonasal approach. Resection of the torus tubarius, Eustachian tube (ET), medial pterygoid plate and muscle, lateral nasal wall, and lateral pterygoid plate and muscle were sequentially performed to expose the fossa of Rosenmuller, petroclival region, parapharyngeal space (PPS), and jugular foramen, respectively. Results Technical feasibility of endonasal nasopharyngectomy toward a posterolateral direction was validated in all 16 sides. Nasopharyngectomy was classified into four types as follows: (1) type 1: resection restricted to the posterior or superior nasopharynx; (2) type 2: resection includes the torus tubarius which is suitable for lesions extended into the petroclival region; (3) type 3: resection includes the distal cartilaginous ET, medial pterygoid plate, and muscle, often required for lesions extending laterally into the PPS; And (4) type 4: resection includes the lateral nasal wall, pterygoid plates and muscles, and all the cartilaginous ET. This extensive resection is required for lesions involving the carotid artery or extending to the jugular foramen region. Conclusion Selected lesions with posterolateral invasion into the PPS or jugular foramen is amenable to a resection via expanded endonasal approach. Classification of nasopharyngectomy based on tumor depth of posterolateral invasion helps to plan a surgical approach.

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出版当年[2021]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 外科
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 外科
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出版当年[2020]版:
Q3 SURGERY Q4 CLINICAL NEUROLOGY
最新[2023]版:
Q3 SURGERY Q4 CLINICAL NEUROLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2020版] 出版当年五年平均 出版前一年[2019版] 出版后一年[2021版]

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第一作者机构: [1]Capital Med Univ, Beijing Tongren Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China [2]Ohio State Univ, Dept Otolaryngol Head & Neck Surg, James Canc Ctr, Wexner Med Ctr, Starling Loving Hall,Room B221,614-685-6778, Columbus, OH 43210 USA
通讯作者:
通讯机构: [2]Ohio State Univ, Dept Otolaryngol Head & Neck Surg, James Canc Ctr, Wexner Med Ctr, Starling Loving Hall,Room B221,614-685-6778, Columbus, OH 43210 USA [4]Ohio State Univ, Dept Neurol Surg, James Canc Hosp, Wexner Med Ctr, Columbus, OH 43210 USA [*1]Department of Otolaryngology—Head and Neck Surgery, The James Cancer Center at The Ohio State University Wexner Medical Center, Starling Loving Hall, Room B221, 614.685.6778, 320 West 10th Avenue, Columbus, OH 43210, United States
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