Endoscopic Resections

In an effort to update current classification systems and to highlight the potential of endoscopic resections in the management of JNA, the authors propose a new staging system.This system attempts to incorporate new observations of proposed sites of origin and spread, potential areas of recurrence and new multi-corridor therapeutic strategies. Author’s staging system is based on analysis of 242 JNA patients treated at our center for the period of 9 years. This classification system is derived from detailed analysis of the preoperative imaging data. Each stage in this classification system assigns patients to a specific treatment group with a defined surgical approach appropriate to address the respective anatomical compartment.
The staging system used at the author’s center …show more content…
The endoscopes has enabled surgeons with magnified superior visualization of tumor margins and extensions in the "blind zones" of the skull base.Endoscopic approaches graduated from wide middle meatal antrostomy to Modified denker's approach stepwise depending on exposure required for excision and surgical manouverability.In case of massive tumor size, staged resections were planned to reduce morbidity.Endoscopic approch allows radical excision of tumor with minimal invasive ness and reduced morbidity with aid of technical adjuncts.

When pure transnasal endoscopic surgery reached its limits, combined approaches were used for complete excision of the tumor. Combined multiport approaches through endoscopic transoral and transorbital were used in cases with extension to prestyloid parapharyngeal region and along middle cranial fossa lying lateral to the superior orbital fissure,