Cases reported "Angiofibroma"

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1/6. Temporal approach for resection of juvenile nasopharyngeal angiofibromas.

    OBJECTIVE: To describe a lateral preauricular temporal approach for resection of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN: A retrospective review of five patients with JNA tumors that were resected by a lateral preauricular temporal approach. methods: The medical records of five patients who underwent resection of JNA tumors via a lateral preauricular temporal approach were reviewed, and the following data collected: tumor extent, blood loss, hospital stay, and surgical complications. RESULTS: Five patients with JNA tumors had resection by a lateral preauricular temporal approach. These tumors ranged from relatively limited disease to more extensive intracranial, extradural tumors. Using the staging system advocated by Andrews et al., these tumors included stages II, IIIa, and IIIb. Four patients (stages II, IIIa, IIIa, and IIIb) who underwent primary surgical excision had minimal blood losses and were discharged on the first or third postoperative day with minimal transient complications (mild trismus, frontal branch paresis, serous effusion, and cheek hypesthesia). The remaining patient (stage IIIb) did well after surgery, despite having undergone preoperative radiation therapy and sustaining a significant intraoperative blood loss. There have been no permanent complications or tumor recurrences. CONCLUSIONS: A lateral preauricular temporal approach to the nasopharynx and infratemporal fossa provides effective exposure for resection of extradural JNA tumors. The advantages of this approach include a straightforward route to the site of origin, the absence of facial and palatal incisions, and avoidance of a permanent ipsilateral conductive hearing loss.
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keywords = blood loss
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2/6. angiofibroma of the larynx: report of a case with clinical and pathologic literature review.

    BACKGROUND: Angiofibromas are uncommon vascular tumors with a strong predilection for the nasopharynx of adolescent males. Although they are slow growing and histologically benign, they have the potential to cause significant morbidity with laryngeal involvement. methods: We describe the clinical characteristics, histopathologic findings, differential diagnosis, preoperative evaluation, and management of a case of laryngeal angiofibroma. RESULTS: The patient was initially seen with a 2 1/2-year history of progressive dyspnea and dysphagia. Preoperative evaluation suggested a vascular mass involving the left supraglottic larynx. A partial laryngopharyngectomy was performed without complication. The patient is alive and disease free 3 years postoperatively. Final histopathologic diagnosis is consistent with angiofibroma. CONCLUSIONS: Laryngeal angiofibroma is an extremely rare entity. Adequate preoperative imaging is necessary to confirm the vascularity of this lesion, because ill-planned biopsy may lead to significant blood loss. The role of preoperative embolization of other laryngeal vascular lesions has been well documented and may be useful in the management of laryngeal angiofibroma.
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keywords = blood loss
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3/6. Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas.

    BACKGROUND: Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular tumors that originate in the nasopharynx of young males. The primary treatment is surgical excision. Traditional surgical approaches are associated with significant morbidity and facial deformity. We introduce and outline the clinical advantages of an endoscopic surgical approach to JNAs using the Nd:YAG laser with image-guided surgery. DESIGN: Case series. SETTING: Tertiary care medical center. patients AND methods: Our study included 5 male patients (age range, 8-21 years) with extensive JNAs. Their tumors were large and ranged from Fisch stage IIA to IIIA. Embolization of tumor-feeding vessels was performed before surgery. The tumors were photocoagulated via a transnasal endoscopic approach using a Nd:YAG laser. Devascularized, lased tumor was removed with a microdebrider. Image-guided navigation systems were used to assist skull base tumor removal, and sublabial and buccolabial incisions were used as needed to gain lateral endoscopic tumor access. Endoscopic tumor margins were obtained for frozen section. RESULTS: All patients achieved symptomatic remission, with no complications. No blood transfusions were necessary. The patients were ready for discharge 1 to 2 days after surgery. Postoperative and magnetic resonance imaging scans showed 2 skull base recurrences, which were removed endoscopically. Follow-up ranged between 2 and 3 years. CONCLUSIONS: Traditional external surgical approaches to large JNAs may result in significant morbidity. Laser-assisted image-guided endoscopic excision of JNAs is a safe and effective minimally invasive surgical treatment. Its distinct advantages include (1) diminished blood loss, (2) superior cosmesis without observed altered facial growth, (3) direct access of skull base with minimal morbidity, and (4) ease of endoscopic follow-up.
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ranking = 0.33333333333333
keywords = blood loss
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4/6. Endoscopic surgery for juvenile angiofibroma: when and how.

    OBJECTIVES/HYPOTHESIS: In recent years, the indications for endoscopic surgery of the sinonasal tract, originally introduced for the treatment of inflammatory diseases, have been expanded to include selected cases of benign and malignant neoplastic lesions. The aim of the present study was to establish the efficacy of endoscopic surgery in the management of small and intermediate-sized juvenile angiofibromas.STUDY DESIGN: Retrospective study. methods: We reviewed the clinical records and the preoperative and postoperative imaging studies of 15 patients with juvenile angiofibroma who were treated with an endoscopic approach after embolization in the period from January 1994 to April 2000. All patients were prospectively followed by endoscopic and magnetic resonance imaging evaluations performed at regular intervals (every 4 months during the first year and, subsequently, every 6 months). RESULTS: According to a staging system reported in 1989, there were two patients with a type I, nine with a type II, three with a type IIIA, and one with a type IIIB juvenile angiofibroma. angiography demonstrated that the vascular supply was strictly unilateral in 11 patients and bilateral in 4. Intraoperative blood loss ranged from 80 to 600 mL (mean blood loss, 372 mL). During follow-up (range, 24-93 mo; mean follow-up, 50 mo [SD /- 19.9 mo]), only one patient presented a residual lesion on magnetic resonance imaging, which was 16 mm in diameter and was detected 24 months after surgery. CONCLUSIONS: The endoscopic approach is a safe and effective technique that allows removal of small and intermediate-sized juvenile angiofibromas (without extensive involvement of the infratemporal fossa and cavernous sinus) with a low morbidity. Advanced lesions are more appropriately treated by external approaches.
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keywords = blood loss
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5/6. Endoscopic surgery for nasal and sinusal vascular tumours: about two cases of nasopharyngeal angiofibromas and one case of turbinate angioma.

    Incomplete resection, technical difficulties and important bleeding are feared in endoscopic sinus surgery (E.S.S.). The authors report three cases of E.S.S. for vascular tumours: two angiofibromas and one angioma. Adjuvant treatments were sometimes used : embolization by angiography (one case), clip on the sphenopalatine artery (one case). However, in one case, E.S.S. alone was sufficient. Average blood loss was 500 cc. Total resection, good clinical evolution and no recurrence at 9 months are good arguments in favour of this technique.
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ranking = 0.33333333333333
keywords = blood loss
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6/6. Intracranial juvenile nasopharyngeal angiofibroma.

    Eight cases of intracranial extensions of juvenile nasopharyngeal angiofibromas (JNA) are presented. These form 33% of the cases of JNA treated during a 5-year period (1988-93). A high incidence of visual complications in this stage of tumour is observed and the basis of this is discussed. death results from serious complications of severe haemorrhage and cerebro-spinal fluid leak. The intradural intracranial extensions of the tumour warrant careful approach in terms of surgery, because of their greater risk for complications during the dissection.
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ranking = 0.00041965377889236
keywords = haemorrhage
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