Endoscopic Endonasal Transpterygoid Nasopharyngectomy

Introduction: This report will provide a summary of our experience with the endoscopic endonasal transpterygoid nasopharyngectomy for the treatment of selected patients with advanced nasopharyngeal malignancies. We will provide a detailed description of the surgical technique and review the most important aspects of the anatomy pertaining to this area.

Methods: Retrospective review of consecutive nasopharyngeal cancer patients treated with endoscopic resection for curative intent at our Skull Base Center.

Results: Seven patients were included in our study. Of the seven patients, two patients had primary stage IV nasopharyngeal tumors, and five patients had recurrent nasopharyngeal tumors (three had recurrent stage III and two had recurrent stage IV). All the surgeries were performed endoscopically, obtaining negative endoscopic margin without the need to convert the approach to a traditional open procedure. One patient with a stage IV mucoepidermoid carcinoma suffered an ICA injury with significant hemorrhage ,which was managed endoscopically. There was no perioperative mortality. The median blood loss in this group of patients was 150 mL (range, 100 to 4000 mL). All seven patients were treated with postoperative adjunctive therapy. The follow-up period ranged from 24 to 56 months (mean, 23 months); four patients were disease-free at the time of last follow-up. The actuarial local control rate was 57% at a mean follow-up of 23 months.

Conclusion: Endoscopic endonasal transpterygoid nasopharyngectomy is a feasible approach for the oncologic surgical treatment of highly selected primary and recurrent nasopharyngeal tumors.