Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors.
OBJECTIVE
To describe the endoscopic transnasal approach to the infratemporal fossa (ITF) and upper parapharyngeal space (UPS) and to analyze the indications and outcomes of this surgical technique in the management of the tumors localized in this critical area.


METHODS
Case series with chart review.


METHODS
Tertiary-care referral center.


METHODS
Retrospective review of patients with benign and malignant tumors arising in or extending to the ITF and UPS, treated from 2002 to 2012 at a single institute. The tumors were surgically resected using an endoscopic endonasal transpterygoid transmaxillary approach.


RESULTS
Thirty-seven consecutive patients with benign tumors (20 juvenile nasopharyngeal angiofibromas, 2 extracranial trigeminal Schwannomas, 2 meningiomas, 1 cavernous hemangioma) and nonmetastatic malignant tumors (2 adenoid-cystic carcinoma, 1 mucoepidermoid carcinoma, 1 squamous cell carcinoma, 1 adenocarcinoma, 1 recurrence of chondrosarcoma, and 6 recurrences of undifferentiated carcinoma of nasopharyngeal type) were treated with curative intent. A gross-total resection was achieved in 35 of 37 patients. Major complications were observed in 1 case (intraoperative internal carotid artery blowout). Postoperatively, 8 patients received some form of adjuvant treatment. Mean follow-up was 30 months for malignancies and 60 months for benign tumors. All patients are now alive without recurrences. Stable intracranial persistence of disease was reported in 2 cases (1 meningioma and 1 adenoid-cystic carcinoma).


CONCLUSIONS
The purely endoscopic endonasal technique may provide a minimally invasive and safe approach to radically resect selected tumors involving the ITF and UPS. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of this technique.
Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
Paolo
P
Battaglia
Mario
M
Turri-Zanoni
Iacopo
I
Dallan
Stefania
S
Gallo
Eleonora
E
Sica
Giovanni
G
Padoan
Paolo
P
Castelnuovo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D009296:Nasal Cavity / Q000601:surgery*; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011379:Prognosis; D056739:Pterygopalatine Fossa / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D019292:Skull Base Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
D003287:Contrast Media
endoscopic endonasal; infratemporal fossa; internal carotid artery; parapharyngeal space; skull base tumor