Laparoscopic approach to liver hydatid cyst : is it safe?

Abstract EN

Objective: To evaluate the long-term outcome after endonasal, endoscopic resection of juvenile nasopharyngeal angiofibromas. Study design: Retrospective study of a series often consecutive patients undergoing endoscopic tumor resection at a University Hospital Center.

All patients were male Caucasians between 13 and 24 years of age. Methods: Ten nasopharyngeal angiofibromas type II - Ilia according to Fisch, were diagnosed via computerized tomography scan or magnetic resonance imaging.

All juvenile nasopharyngeal angiofibromas were resected via a combined endonasal peroral endoscopic approach.

In three cases of type Ilia tumors a computer assisted intraoperative guiding system was applied (ENTrak, GE Medical, Lawrence, USA).

Follow up checks included routine nasal endoscopy and regular magnetic resonance imaging. Results: Ten consecutive patients underwent endonasal endoscopic juvenile nasopharyngeal angiofibromas resection.

In two patients (20 %) an unmistakable recurrence with the need for further treatment was detected at 14 and 23 months after surgery respectively.

One of the two recurrent tumors was successfully resected endoscopically.

The second recurrence with infiltration of the skull base was treated with gamma knife.

Eight patients (80%) were free of symptoms and showed a tumor free operation cavity with nasal endoscopy.

In two of these patients and the patient, who underwent revision surgery postoperative magnetic resonance imaging showed localized enhanced signal, supposedly minimal residual tumor tissue.

Magnetic resonance imaging follows up showed no growth and all three patients were free of symptoms over three, five, or nine years respectively and no further treatment was required. Extension to the medial aspect of infratemporal fossa and retromaxillary space was not a contraindication against an endonasal endoscopic approach.

Feeders from the internal carotid artery could effectively be dealt with endoscopically.

The mean follow up was 39.1 months (range 5 months to 9 years) and the mean postoperative hospitalization was 6.2 days, with minimal postoperative morbidity.

There was no surgical complications observed.

The overall success rate in this case series was 90%, including one patient undergoing a second endoscopic resection and three symptom free patients with non growing minimal residual tumor tissue. Conclusion: Resection of nasopharyngeal angiofibromas type II-IIIa can be safely achieved endoscopically.

The advantage of this minimally invasive technique is the avoidance of external scars, shorter hospitalization, and low morbidity.

The intraoperative computer assisted guiding system ENTrak was highly accurate and provided substantial help.