Download PDF
J Neurol Surg B Skull Base 2022; 83(S 02): e537-e544
DOI: 10.1055/s-0041-1735557
Original Article

An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension

Lifeng Li 
1   Department of Otolaryngology—Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
2   Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
,
Nyall R. London Jr.
2   Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
3   Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
,
Daniel M. Prevedello 
2   Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
4   Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
,
Ricardo L. Carrau
2   Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
4   Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

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 Rosenmüller, 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.

Keywords

nasopharyngectomy - fossa of Rosenmüller - jugular foramen - petroclival region - expanded endonasal approach


Publication History

Received: 17 March 2021

Accepted: 25 July 2021

Article published online:
29 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Carrau RL. Skull base surgery in the 21st century: accelerated revolution. Int Arch Otorhinolaryngol 2014; 18 (Suppl. 02) S121-S122
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Prevedello DM, Ditzel Filho LF, Solari D, Carrau RL, Kassam AB. Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors. Neurosurg Clin N Am 2010; 21 (04) 621-635 , vi
    CrossrefPubMedGoogle Scholar
  • 3 Zanation AM, Snyderman CH, Carrau RL, Gardner PA, Prevedello DM, Kassam AB. Endoscopic endonasal surgery for petrous apex lesions. Laryngoscope 2009; 119 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 4 Stippler M, Gardner PA, Snyderman CH, Carrau RL, Prevedello DM, Kassam AB. Endoscopic endonasal approach for clival chordomas. Neurosurgery 2009; 64 (02) 268-277 , discussion 277–278
    CrossrefPubMedGoogle Scholar
  • 5 Li L, London Jr. NR, Chen X, Prevedello DM, Carrau RL. Characterization and implications of the lingual process of the sphenoid bone: a cadaveric and radiographic study. Int Forum Allergy Rhinol 2020; 10 (12) 1316-1321
    CrossrefPubMedGoogle Scholar
  • 6 Pant H, Bhatki AM, Snyderman CH. et al. Quality of life following endonasal skull base surgery. Skull Base 2010; 20 (01) 35-40
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Ong YK, Solares CA, Carrau RL, Snyderman CH. New developments in transnasal endoscopic surgery for malignancies of the sinonasal tract and adjacent skull base. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (02) 107-113
    CrossrefPubMedGoogle Scholar
  • 8 Liu YP, Xie YL, Zou X, You R, Yang Q, Chen MY. Techniques of endoscopic nasopharyngectomy for localized stage I nasopharyngeal carcinoma. Head Neck 2020; 42 (04) 807-812
    CrossrefPubMedGoogle Scholar
  • 9 Vlantis AC, Lee DL, Wong EW, Chow SM, Ng SK, Chan JY. Endoscopic nasopharyngectomy in recurrent nasopharyngeal carcinoma: a case series, literature review, and pooled analysis. Int Forum Allergy Rhinol 2017; 7 (04) 425-432
    CrossrefPubMedGoogle Scholar
  • 10 Roger V, Patron V, Moreau S, Kanagalingam J, Babin E, Hitier M. Extended endonasal approach versus maxillary swing approach to the parapharyngeal space. Head Neck 2018; 40 (06) 1120-1130
    CrossrefPubMedGoogle Scholar
  • 11 Liu J, Yu H, Sun X. et al. Salvage endoscopic nasopharyngectomy for local recurrent or residual nasopharyngeal carcinoma: a 10-year experience. Int J Clin Oncol 2017; 22 (05) 834-842
    CrossrefPubMedGoogle Scholar
  • 12 Ng LS, Lim CM, Loh KS. Long-term outcomes of nasopharyngectomy using partial maxillectomy approach. Laryngoscope 2016; 126 (05) 1103-1107
    CrossrefPubMedGoogle Scholar
  • 13 Chan JY, Tsang RK, Wei WI. Morbidities after maxillary swing nasopharyngectomy for recurrent nasopharyngeal carcinoma. Head Neck 2015; 37 (04) 487-492
    CrossrefPubMedGoogle Scholar
  • 14 Chan JY. Surgical salvage of recurrent nasopharyngeal carcinoma. Curr Oncol Rep 2015; 17 (03) 433
    PubMedGoogle Scholar
  • 15 Wong EHC, Liew YT, Abu Bakar MZ, Lim EYL, Prepageran N. A preliminary report on the role of endoscopic endonasal nasopharyngectomy in recurrent rT3 and rT4 nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2017; 274 (01) 275-281
    CrossrefPubMedGoogle Scholar
  • 16 Hosseini SM, McLaughlin N, Carrau RL. et al. Endoscopic transpterygoid nasopharyngectomy: correlation of surgical anatomy with multiplanar CT. Head Neck 2013; 35 (05) 704-714
    CrossrefPubMedGoogle Scholar
  • 17 Castelnuovo P, Nicolai P, Turri-Zanoni M. et al. Endoscopic endonasal nasopharyngectomy in selected cancers. Otolaryngol Head Neck Surg 2013; 149 (03) 424-430
    CrossrefPubMedGoogle Scholar
  • 18 Castelnuovo P, Dallan I, Bignami M. et al. Nasopharyngeal endoscopic resection in the management of selected malignancies: ten-year experience. Rhinology 2010; 48 (01) 84-89
    PubMedGoogle Scholar
  • 19 Vaz-Guimaraes F, Nakassa ACI, Gardner PA, Wang EW, Snyderman CH, Fernandez-Miranda JC. Endoscopic endonasal approach to the ventral jugular foramen: anatomical basis, technical considerations, and clinical series. Oper Neurosurg (Hagerstown) 2017; 13 (04) 482-491
    CrossrefPubMedGoogle Scholar
  • 20 Al-Sheibani S, Zanation AM, Carrau RL. et al. Endoscopic endonasal transpterygoid nasopharyngectomy. Laryngoscope 2011; 121 (10) 2081-2089
    CrossrefPubMedGoogle Scholar
  • 21 Becker AM, Hwang PH. Endoscopic endonasal anatomy of the nasopharynx in a cadaver model. Int Forum Allergy Rhinol 2013; 3 (04) 319-324
    CrossrefPubMedGoogle Scholar
  • 22 Chan JY, Chow VL, Tsang R, Wei WI. Nasopharyngectomy for locally advanced recurrent nasopharyngeal carcinoma: exploring the limits. Head Neck 2012; 34 (07) 923-928
    CrossrefPubMedGoogle Scholar
  • 23 Chen MY, Wen WP, Guo X. et al. Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma. Laryngoscope 2009; 119 (03) 516-522
    CrossrefPubMedGoogle Scholar
  • 24 Labib MA, Belykh E, Cavallo C. et al. The endoscopic endonasal eustachian tube anterolateral mobilization strategy: minimizing the cost of the extreme-medial approach. J Neurosurg 2020; 134 (03) 831-842
    CrossrefPubMedGoogle Scholar
  • 25 Li L, London Jr. NR, Prevedello DM, Carrau RL. Role of resection of torus tubarius to maximize the endonasal exposure of the inferior petrous apex and petroclival area. Head Neck 2021; 43 (02) 725-732
    CrossrefPubMedGoogle Scholar
  • 26 Kasemsiri P, Solares CA, Carrau RL. et al. Endoscopic endonasal transpterygoid approaches: anatomical landmarks for planning the surgical corridor. Laryngoscope 2013; 123 (04) 811-815
    CrossrefPubMedGoogle Scholar
  • 27 Falcon RT, Rivera-Serrano CM, Miranda JF. et al. Endoscopic endonasal dissection of the infratemporal fossa: anatomic relationships and importance of eustachian tube in the endoscopic skull base surgery. Laryngoscope 2011; 121 (01) 31-41
    CrossrefPubMedGoogle Scholar
  • 28 Freeman JL, Sampath R, Quattlebaum SC. et al. Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis. J Neurosurg 2018; 128 (06) 1855-1864
    CrossrefPubMedGoogle Scholar
  • 29 Li L, London Jr. NR, Gao Y, Carrau RL, Chen X. Endoscopic transoral approach for resection of retrostyloid parapharyngeal space tumors: retrospective analysis of 16 patients. Head Neck 2020; 42 (12) 3531-3537
    CrossrefPubMedGoogle Scholar
  • 30 Oakley GM, Harvey RJ. Endoscopic resection of pterygopalatine fossa and infratemporal fossa malignancies. Otolaryngol Clin North Am 2017; 50 (02) 301-313
    CrossrefPubMedGoogle Scholar
  • 31 Salom MC, López F, Pacheco E. et al. Salvage surgery in the treatment of local recurrences of nasopharyngeal carcinomas. Acta Otorrinolaringol Esp (Engl Ed) 2018; 69 (06) 339-344
    PubMedGoogle Scholar
  • 32 Ünsaler S, Başaran B, Aslan I, Yilmazbayhan D. Endonasal endoscopic nasopharyngectomy for the treatment of nasopharyngeal papillary adenocarcinoma: Report of a rare case. Int J Pediatr Otorhinolaryngol 2018; 104: 51-53
    CrossrefPubMedGoogle Scholar
  • 33 Grayson JW, Khichi SS, Cho DY, Riley KO, Woodworth BA. Management strategies for skull base inverted papilloma. Otolaryngol Head Neck Surg 2016; 155 (01) 179-183
    CrossrefPubMedGoogle Scholar
  • 34 Liu Q, Sun X, Li H. et al. Types of transnasal endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: Shanghai EENT Hospital experience. Front Oncol 2021; 10: 555862
    CrossrefPubMedGoogle Scholar