Endoscopic Transnasal Approach to the Infratemporal and Upper Parapharyngeal Tumors: Indications and Outcomes

Objectives: Describe the endoscopic transnasal approach to the infratemporal fossa (ITF) and upper parapharyngeal region (UPR), and analyze the indications and outcomes of this surgical technique in the management of the tumors localized in this critical area. Methods: Retrospective review of patients with benign and malignant tumors arising in or extending to the ITF and UPR, treated from 2002 to 2012 at a single institute. The tumors were surgically resected using an endoscopic transnasal transmaxillary transpterygoid approach, combined with a posterior septotomy to improve the controlateral maneuverability of surgical instruments. Results: Thirty-one consecutive patients with benign tumors (20 juvenile nasopharyngeal angiofibromas, 2 extracranial trigeminal schwannomas, 2 meningiomas, and 1 cavernous hemangioma) and malignancies (2 adenoid-cystic carcinoma, 1 mucoepidermoid carcinoma, 1 squamous-cell carcinoma, 1 adenocarcinoma, and 1 recurrence of chondrosarcoma after chemo-radiation therapy) were treated with curative intent. A gross-total resection was achieved in 28/30 patients. Major complications were observed in 1 case (intra-operative internal carotid artery blowout), and minor complications (postoperative palate and/or cheek numbness) were observed in 4 cases. Postoperatively, the 5 primitive malignancies received intensity-modulated radiotherapy. Mean follow-up was 30 months for malignancies and 54 months for benign tumors. All patients are now alive without recurrences, with stable intracranial persistence of disease in 2 cases (1 meningioma and 1 adenoid-cystic carcinoma). Conclusions: The purely endoscopic transnasal technique may provide a minimally-invasive and safe approach to resect selected tumors involving the ITF and UPR. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of this technique.