Volumetric Analysis of Endoscopic and Maxillary Swing Surgical Approaches for Nasopharyngectomy

Nidal Muhanna; Harley Chan; Jimmy Qiu; Michael Daly; Tahsin Khan; Francesco Doglietto; Walter Kucharczyk; David P. Goldstein; Jonathan C. Irish; John R. de Almeida

doi:10.1055/s-0037-1617432

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2018; 79(05): 466-474
DOI: 10.1055/s-0037-1617432

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Volumetric Analysis of Endoscopic and Maxillary Swing Surgical Approaches for Nasopharyngectomy

Nidal Muhanna

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

²Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada

³Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada

,

Harley Chan

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

,

Jimmy Qiu

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

,

Michael Daly

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

,

Tahsin Khan

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

,

Francesco Doglietto

⁴Department of Neurosurgery, University of Brescia, Owensboro, Kentucky 42301, United States

,

Walter Kucharczyk

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

⁵Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada

,

David P. Goldstein

²Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada

³Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada

,

Jonathan C. Irish

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

²Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada

³Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada

,

John R. de Almeida

¹TECHNA Institute, University Health Network, Toronto, Ontario, Canada

²Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada

³Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada

› Institutsangaben

Abstract

Objectives/Hypothesis The endoscopic endonasal approach (EEA) for nasopharyngectomy is an alternative to the maxillary swing approach (MSA) for selected recurrent nasopharyngeal carcinomas (NPC). We compare the access between these approaches.

Methods Three cadaver specimens were used to compare access volumes of the EEA and MSA. Exposure volumes were calculated using image guidance registration to cone beam computed tomography and tracking of accessible tissue with volumetric quantification. The area of exposure to the carotid artery was measured.

Results The MSA provided higher volumes for access volume compared with the EEA (66.6 vs 39.1 cm³, p = 0.009). The working area was larger in the MSA (80.2 vs 56.9 cm², p = 0.06). The exposure to the carotid artery was higher in the MSA (1.88 vs 1.62 cm², p = 0.04). The MSA provided larger volume of exposure for tumors of the parapharyngeal space with exposure below the palate.

Conclusions This study suggests that the MSA for nasopharyngectomy provides a larger volume of exposure. However, much of the increased exposure relates to exposure of the parapharyngeal space below the palate. The EEA provides adequate access to superior anatomical structures.

Keywords

endoscopic - maxillary swing - exposure volume - image guidance - nasopharyngectomy

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Referenzen

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