Placing covered self-expanding metal stents by suspension laryngoscope in benign tracheal stenosis.

BACKGROUND: Tracheobronchial stent placement for malignant airway strictures has been proved to improve respiratory function, but experience for benign tracheobronchial stenoses is limited. The purpose of our study is to investigate the efficacy of covered expandable metallic stents, inserted through a suspension laryngoscope, treating tracheal stenosis following intubation or tracheostomy. METHODS: From 2010 to 2018, 67 adult patients with the benign tracheal stenosis, underwent stent placement, using a suspension laryngoscope. According to the date of stent placement and stent caliber, these patients have been subdivided into two groups: Group 1 (from 2010 to 2013, stent caliber ranging from 16 to 20 mm) and Group 2 (from 2014 to 2018, stent caliber ranging from 18 to 22 mm). Complications, related reinterventions, and long-term prognosis were retrospectively evaluated. RESULTS: Primary successful stent placement was achieved and symptoms were improved in all patients. Complications occurred in 27 (40.3%) cases. Among these, there were 14 (20.9%) cases with stent migration, 10 (14.93%) with granulation tissue formation and 3 (4.48%) with pneumonia. Stent migration in Group 1 was nearly 30% higher than that in Group 2 (P = 0.002). Five of the 8 patients who had placement of 16 mm stents had stent migration, more often than with 20 mm stents (P = 0.002). Ten patients' trachea had slight narrowing but without any symptoms. Six patients still had granulation tissue but without any growth at least two-year follow-up (2 patients whose stents were removed more than 1 year after placement). Even without tracheal narrowing and granulation tissue, 5 patients felt persistent shortness of breath. 92.5% of the patients reported to be satisfied with significant improvement in symptoms. CONCLUSIONS: Patients with tracheal obstruction secondary to intubation or tracheostomy can benefit from tracheal stents. Placing 16 mm stents might lead to stent migration more easily than 20 mm stents. Tracheal stents placed by a suspension laryngoscope provide a reasonable alternative to open surgery for patients with benign tracheal stenosis or obstruction.

Treatment of Intracranial Pseudoaneurysms With a Novel Covered Stent: A Series of 19 Patients With Midterm Follow-Up.

Background: The optimal treatment for intracranial pseudoaneurysm is unclear. This study aims to analyze the outcome of treating intracranial pseudoaneurysm with a novel covered stent. Materials and Methods: The institutional imaging and clinical databases were retrospectively reviewed for patients with intracranial pseudoaneurysms treated with Willis covered stent from January 2017 to December 2019. The clinical presentations, etiology, intraoperative complications, and immediate and follow-up outcomes were analyzed. Results: A total of 19 patients with 20 pseudoaneurysms were enrolled for analysis. Seventeen patients presented with vision loss and two with epistaxis. Nineteen Willis covered stents were used with one for each patient without technical failure. Intraoperative thrombosis was encountered in one patient (5.3%), which was recanalized by tirofiban. During clinical follow-up, no further epistaxis occurred, and visual acuity improved in three (17.6%) patients. Endoleak occurred in seven (36.8%) patients after the initial balloon inflation and persisted in one (5.3%) patient after balloon re-inflation. This endoleak disappeared at 8 month follow-up. Finally, during angiographic follow-up (median 13 months), parent artery occlusion and in-stent stenosis occurred in one (5.3%) patient. No stent-related ischemic event was encountered. Conclusions: The Willis covered stent is feasible, safe, and efficient in treating intracranial pseudoaneurysms.

Characteristics of Nitrogen Removal and Extracellular Polymeric Substances of a Novel Salt-Tolerant Denitrifying Bacterium, Pseudomonas sp. DN-23.

Extracellular polymeric substances (EPS) influence the auto-aggregation performance of cells and play an important role in nitrogen removal during wastewater treatment. In this study, a salt-tolerant aerobic denitrifying bacterium was isolated from tannery wastewater and identified as Pseudomonas sp. DN-23. The strain exhibited significant growth and denitrifying performance, with NaCl contents ranging from 0 to 50 g/L, and high antioxidative enzyme activity, especially that of catalase (CAT), was detected under salt stress. Even greater auto-aggregation ability was observed with elevated NaCl content. Extinction-emission matrix (EEM) and Fourier-transform infrared (FTIR) spectrum analyses showed that the main components of EPS were proteins and polysaccharides. The polysaccharide content was almost unaffected by NaCl stress, while the protein content increased with NaCl stress, and the proteins may play a more important role in auto-aggregation. Analysis of the contents of each protein's secondary structure suggested that ß-Sheets increased with increasing NaCl content, which may be related to the increase of auto-aggregation ability in response to NaCl stress. Therefore, NaCl stress increased the auto-aggregation performance by altering the compositions of EPS and the distribution of protein secondary structures. This study provided further insight into the denitrifying performance, and the relationship between aggregation ability and EPS characteristics under NaCl stress.

Effect of chemical oxygen demand load on the nitrification and microbial communities in activated sludge from an aerobic nitrifying reactor.

In this study, we explored the effect of chemical oxygen demand (COD) load on the nitrification and microbial communities in activated sludge isolated from an aerobic nitrifying tank. The activated sludge was cultured in three different COD groups: L-COD, 200 mg/L; M-COD, 1200 mg/L; H-COD, 4200 mg/L. The results indicated that the COD exerts a negligible effect on the nitrogen removal ability within the first 24 h. However, the nitrification rate decreased with culture time; the ammonium degradation rates were found to be 80.26%, 57.56%, and 43.43% at 72 h in the three COD groups, respectively. These values correspond to decreases of 19.40%, 41.83%, and 51.48%, respectively, in relation to those observed at 24 h. The activated sludge in the different COD groups exhibited similar community compositions after 24 h, as assessed by Illumina high-throughput sequencing, while a significant difference in the relative abundances of some organisms occurred after 48 and 72 h. Proteobacteria was the main phylum, with a relative abundance of >51.45%. The genera Aridibacter, Paracoccus, Nitrospira, and Nitrosomonas were suppressed by COD load over time. This study may contribute to our knowledge about the nitrification ability and microbial communities in activated sludge at different COD load levels.

Isolation and Nitrogen Removal Characteristics of an Aerobic Heterotrophic Nitrifying-Denitrifying Bacterium, Klebsiella sp. TN-10.

Nitrogen removal by microorganisms has attracted increasing attention in wastewater treatment. In the present study, a heterotrophic nitrification bacterium was isolated from tannery wastewater and identified as Klebsiella sp. TN-10 based on phenotypic and phylogenetic characteristics. The optimal conditions for cell growth and nitrogen removal were investigated, and the results showed that the greatest ammonium removal rate and maximum biomass were achieved by using sodium pyruvate (7 g/L) as carbon source, C/N 12, pH 7, and temperature 30 °C. Under optimal conditions, the removal rate of ammonia nitrogen reached 96%. Besides, the growth characteristic and the ability of utilizing nitrate and nitrite were investigated. The results demonstrated that strain TN-10 exhibited excellent characteristics to remove both nitrate and nitrite, with the removal rate of 95.44% and 99.87%, respectively. In addition, the nitrite reductase (NiR) and nitrate reductase (NR) involved in denitrification were both active, with the activities of 0.0815 and 0.0283 U/mg proteins, respectively. Furthermore, the aggregation ability, auto-aggregation kinetics, and the relationship between zeta potentials and flocculating efficiency were determined. These results indicated that the strain Klebsiella sp. TN-10, with efficient heterotrophic nitrification-aerobic denitrification ability, has potential application in wastewater treatment.

Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience.

OBJECTIVE: To evaluate clinical characteristics and present surgical outcomes of PT caused by sigmoid sinus wall dehiscence (SSWD). METHODS: This study retrospectively reviewed 34 patients with PT who were diagnosed with SSWD in our institution between December 2008 and July 2013. Among them, 27 patients underwent sigmoid sinus wall reconstruction (surgery group) and 7 patients refused surgery (non-surgery group). Preoperative data were obtained from the patients' medical records. All patients were followed up regularly for at least 25 months. Preoperative and postoperative computed tomography angiography (CTA) images were compared. Student's t-tests were used to compare age, body mass index (BMI) and preoperative Tinnitus Handicap Inventory (THI) scores between the surgery and the non-surgery groups and to compare pre- and follow-up THI scores. RESULTS: There was no significant difference in age, body mass index, or preoperative THI scores between groups. Following surgery, 14 patients had complete resolution, 5 had partial resolution, 7 experienced no change and PT was aggravated in 1 patient. The difference between preoperative and postoperative THI scores was significant. No severe complications were found postoperatively. Comparison of the preoperative and postoperative CTA images revealed that remnant unrepaired dehiscences were the cause of unsatisfactory outcomes following surgery. In the non-surgery group, PT remained largely unchanged. CONCLUSIONS: Sigmoid sinus wall reconstruction is an effective and safe treatment for PT caused by SSWD. It is imperative that all regions of the dehiscence are sufficiently exposed and resurfaced during surgery.

[Clinical application of internal carotid artery occlusion].

OBJECTIVE: To evaluate the efficiency of the internal carotid artery (ICA) occlusion in treatment of head and neck diseases. METHODS: To retrospectively analyze 28 cases related with the ICA. According to the result of balloon test occlusion (BTO) and cerebral angiogram, the balloon, spring coil or glue were used to block the fistula or haemorrhage, sometimes even to embolism the related ICA. RESULTS: Twenty-six cases and 2 cases presented negative and positive in total 28 cases in BTO. Of the 26 patients, 22 were succeed in ICA occlusion. The clinical symptoms disappeared in some patients, and the others had the related tumor or foreign body being resected. Two cases (glomus jugulare tumors and intractable epistaxis after Juvenile nasopharyngeal angiofibroma surgery in 1 case respectively) presented delayed cerebral infarction. With the thrombolysis anticoagulant therapy, the clinical symptoms in the former disappeared and in the later reduced. The balloon was let out in 1 case with the embolism the distal middle cerebral artery branches. However, the patient did not show any symptoms during the operation and observation period. One case with intractable epistaxis in nasopharygeal cancer after radiotherapy was dead. In emergency, the left ICA was blocked, then bleeding reduced with the left hemisphere presented extensive cerebral embolism. However, he died in nasal bleeding in three days. CONCLUSIONS: ICA occlusion was an efficient method to save the life. Moreover, the patient's tolerance and collateral circulation should be evaluated in detail before the operation.

[Features of clinical presentation, pathology and magnetic resonance or computed tomography imaging for ocular lymphoma].

OBJECTIVE: To explore the distribution and magnetic resonance imaging or computed tomography (MRI/CT) of lymphoma in orbit. METHODS: Retrospective analyses were conducted for 73 cases with ocular complaints at Beijing Tong'ren Hospital from June 2006 to September 2012. They were confirmed pathologically as lymphoma with complete MRI/CT records. RESULTS: Ocular adnexal lymphoma occurred predominantly in adults. There were 47 males and 26 females with a median age of (60 ± 12.0) years. The lesions were bilateral (n = 24), right side (n = 23) and left side (n = 26) respectively. The pathological types included mucosa-associated lymphoid tissue (MALT) lymphoma (n = 59), diffuse large B-cell lymphoma (DLBCL, n = 7), mantle cell lymphoma (MCL, n = 3), lymphoplasmacytic lymphoma (LPL, n = 2) and follicular lymphoma and natural killer/T-cell lymphoma (FL and NKT, n = 1) respectively. They had well-defined margins in 64 sides, less well-defined margins in 17 sides and ill-defined margins in 16 sides. And 29 sides of lesions presented as a regional mass within conjunctiva in 16/97 sides (16.5%), lacrimal gland in 5/97 sides (5.2%), eyelids in 3/97 sides (3.1%), ocular muscle in 2/97 sides (2.1%) and lacrimal sac in 3/97 sides (3.1%). Moreover, 68 sides of lesion were diffusely distributed. The invaded sites included preseptal region in 38/97 sides (39.2%), extraconal compartment in 69/97 sides (71.1%), intraconal compartment in 54/97 sides (55.7%), eyeball region in 45/97 sides (46.4%), subperiosteum in 14/97 sides (14.4%), cone compartment in 73/97 sides (75.3%), lacrimal gland in 38/97 sides (39.2%) and sheath of optic nerve in 33/97 sides (34.0%). And, on MRI scan, 70 cases (94 sides) had isointensity in 88/94 sides, hypointensity in 6/94 sides on T1WI and isointensity in 52/94 sides, mild hypointensity in 40/94 sides or mixed signal in 2/94 sides on T2WI. In addition, the signals were homogeneous in 67/94 sides and heterogeneous in 27/94 sides. After contrasting, these lesions showed mild contrast-enhancement (CE) in 27/94 sides, moderate CE in 67/94 sides with homogeneous CE in 52/94 sides and heterogeneous CE in 42/94 sides. On CT scan, 21 cases (24 sides) had isodensity in 18/24 sides and mild hyperdensity in 6/24 sides with homogeneous in 7/24 sides and heterogeneous in 17/24 sides. Moreover, most adjacent bone show no change (16/24 sides). Only 16/24 sides and 2/24 sides showed reformation or destruction respectively. At the same time, the lesions also involved other para-orbit structures, such as orbital apex (27/97 sides, 27.8%), fissure orbitalis inferior (14/97 sides, 14.4%), fossa pterygopalatina (10/97 sides, 10.3%), supraorbital nerve (8/97 sides, 8.2%), cavernous sinus (8/97 sides, 8.2%) and facial soft tissue (6/97 sides, 6.2%), et al. CONCLUSION: Ocular adnexal lymphoma occurs predominantly in male adults. And multiple strictures and sites are often involved. There is iso-/mild hyperintensity with mild-to-moderate homo-/heterogeneous CE and little change of adjacent bone on T1WI and T2WI.

[CT analysis of dehiscent sigmoid plate presenting as pulsatile tinnitus].

OBJECTIVE: To evaluate the CT the characteristics of dehiscent sigmoid plate accompanied with pulsatile tinnitus (PT). METHODS: Dual phase contrast enhancement CT data of 15 PT patients were analyzed retrospectively. RESULTS: Dehiscent sigmoid plate was located on the same side of PT in all patients. Thirteen defects had been showed in both CT images and surgery. Among of them, eight defects located on the descending segment, 3 on the superior curve, and the other 2 defects involved the superior curve and descending segment of sigmoid sinus simultaneously. The maximum anteroposterior and vertical diameters of defect measured in CT images were significant larger than that measured during surgery. There were still 5 defects showed in CT images, which did not been found during surgery. Among 9 patients with unilateral dominant brain venous systems, all the dehiscent sigmoid plates were seen on the dominant side. The other 2 patients showed co-dominant brain venous systems, whose the dehiscent sigmoid plates were on the left side. In addition, extensive pneumatized temporal bone filled with air was found in all patients. CONCLUSION: Dehiscent sigmoid plate commonly located on the anterior, lateral, or anterolateral wall of the superior curve or descending segment of the sigmoid plate, which usually coexist with the strong unilateral dominant brain venous system and extensive temporal bone pneumatization.

Clinical characteristics of pulsatile tinnitus caused by sigmoid sinus diverticulum and wall dehiscence: a study of 54 patients.

CONCLUSIONS: CT angiography (CTA) and digital subtraction angiography (DSA) are valuable tools in imaging work-ups for the diagnosis of sigmoid sinus diverticulum (SSD) and sigmoid sinus wall dehiscence (SSWD). The development of pulsatile tinnitus (PT) resulting from SSD and SSWD may be associated with the dominance of venous systems. OBJECTIVE: Our goal was to evaluate the clinical characteristics of PT caused by SSD and SSWD. METHODS: This was a retrospective chart review undertaken in a tertiary academic referral center. Fifty-four patients with PT due to SSD and SSWD were recruited. Hospital files of these patients were assessed. Data included medical history, physical examinations, auxiliary examinations, and radiographic findings of CTA and DSA. RESULTS: The study population comprised 51 females and 3 males. Most patients with PT caused by SSD and SSWD were middle-aged women. All had normal otoscopy results. Anomalies occurred in or adjacent to the region of the transverse-sigmoid sinus junction in 52 patients. Half of the patients (27/54) presented abnormal results of examination of blood lipids. There were 57.41% (31/54) cases with ipsilateral dominance of the venous system, 9.26% (5/54) cases with contralateral dominance, and 33.33% (18/54) cases with co-dominance of the venous system.

[Value of temporal bone dual phase contrast enhancement computed tomography in diagnosing causes of pulsatile tinnitus].

OBJECTIVE: To evaluate the value of temporal bone dual phase contrast enhancement computed tomography (DPCT) in diagnosing the causes of pulsatile tinnitus (PT). METHODS: We retrospectively analyzed the DPCT findings of 157 patients with unilateral PT. Temporal bone High-resolution CT (HRCT) was performed in 71 patients, magnetic resonance imaging (MRI) in 80 and digital subtraction angiography (DSA) in 89. RESULTS: In 71 patients with both DPCT and HRCT scan, a total of 68 causes were found. The accuracy of DPCT was 100% it was significant higher than that of HRCT (77.9%). In 80 patients with both DPCT and MRI, 83 causes were known. The accuracy of DPCT (94.0%) was significantly higher than that of MRI (8.4%). In 89 patients with both DPCT and DSA scan, 99 causes were identified. The accuracy of DPCT was 91.9% and it was significantly higher than that of DSA (15.2%). CONCLUSION: DPCT may be an ideal imaging modality for diagnosing the causes of PT.

[Role of computed tomographic angiography in the evaluations of dural arteriovenous fistulas with pulsatile tinnitus as initial symptom].

OBJECTIVE: To evaluate the sensitivity and specificity of computed tomographic angiography ( CTA) for dural arteriovenous fistulas ( DAVFs) in patients presenting with pulsatile tinnitus( PT). METHODS: The clinical and imaging data were collected for all patients undergoing CTA for PT from 2008 to 2012. Nine PT patients with DAVFs confirmed by digital subtraction angiography ( DSA) and 9 age and gender-matched control PT patients without DAVFs were selected. The CTA images were blindly analyzed by two experienced neuroradiologists for the following signs: asymmetric venous collaterals in extracranial space , asymmetric attenuation of internal jugular vein ( IJV) , asymmetric external carotid artery( ECA) branches, "shaggy" appearance of dural venous sinus, multiple transcalvarial channels, enlarged foramen spinosum, asymmetric cavernous sinus and enlarged cortical veins. RESULTS: The sensitivities of the following DAVFs signs were quite different: asymmetric attenuation of IJV ( 89% ) , asymmetric venous collaterals ( 89%) , asymmetric ECA branches ( 78%) , shaggy dural venous sinus ( 67%) , multiple transcalvarial channels (67%), enlarged foramen spinosum (56%), stenosis of venous sinus (33%) and asymmetric cavernous sinus ( 2 2 % ) . The presence of asymmetric attenuation of IJV , asymmetric ECA branches, shaggy dural venous sinus, multiple transcalvarial channels and asymmetric cavernous sinus all demonstrated a highly specificity of 100% while the presence of asymmetric venous collaterals and enlarged foramen spinosum had a specificity of 89% . The presence of stenosis of venous sinus revealed a specificity of 78%. Enlarged cortical veins were all absent. CONCLUSION: CTA may be used as a screening examination for DA VFs in PT patients. The presence of asymmetric venous collaterals, asymmetric attenuation of UV,asymmetric ECA branches, shaggy dural venous sinus and multiple transcalvarial channels has a high sensitivity and specificity for diagnosis. Enlarged ECA branches usually serve as DA VFs feeders.Meanwhile, DA VF should be considered in PT patients when multiple transcalvarial channels and enlarged foramen spinosum are detected on high-resolution CT of temporal bone.

Petrosquamosal sinus in the temporal bone as a cause of pulsatile tinnitus: a radiological detection.

We report a newly evidenced cause of venous pulsatile tinnitus--the petrosquamosal sinus in the temporal bone. We also present the case of a 45-year-old woman who presented with an incapacitating objective pulsatile tinnitus in the left ear for 10 years. The radiology evidenced a petrosquamosal sinus in the air cells of the left temporal bone. The symptoms of pulsatile tinnitus disappeared completely after surgical treatment.

Sigmoid sinus diverticulum and pulsatile tinnitus: analysis of CT scans from 15 cases.

BACKGROUND: Although the imaging features of sigmoid sinus diverticulum induced pulsatile tinnitus (PT) have been presented in some extent, detailed imaging findings still have not been systematically evaluated and precise diagnostic radiographic criteria has not been established. PURPOSE: To examine the computed tomography (CT) characteristics of sigmoid sinus diverticulum accompanied with PT. MATERIAL AND METHODS: Fifteen PT patients with sigmoid sinus diverticula proven by surgery were recruited after consenting. CT images of 15 patients were obtained and analyzed, including features of diverticula, brain venous systems, integrity of the sigmoid plate, and the degree of temporal bone pneumatization. RESULTS: Sigmoid sinus diverticulum was located on the same side of PT in 15 patients. Diverticula originated at the superior curve of the sigmoid sinus in 11 patients and the descending segment of the sigmoid sinus in four patients. Sigmoid sinus diverticula focally eroded into the adjacent mastoid air cells in 12 patients and mastoid cortex in three patients. Among eight patients with unilateral dominant brain venous systems, the diverticula were seen on the dominant side in seven patients and non-dominant side in one patient. In contrast, the other seven patients showed co-dominant brain venous systems, with three presenting diverticula on the right side and four on the left. More notably, dehiscent sigmoid plate on the PT side was demonstrated in all patients. In addition, temporal bone hyper-pneumatization was found in nine patients, good and moderate pneumatization in three patients, respectively. CONCLUSION: Dehiscent sigmoid plate and extensive temporal bone pneumatization are two important imaging characteristics of the PT induced by sigmoid sinus diverticulum.

[Complications and the management of fully covered retrievable metal stent placement in benign tracheal stenosis].

OBJECTIVE: To study complications and the management of the use of covered retrievable expandable metallic stents in the treatment of benign tracheal stenosis. METHODS: Fully covered retrievable metal stents were placed in 21 patients with benign tracheal stenosis. Stent-related complications and the management were reviewed and analysed. RESULTS: Twenty-eight fully covered retrievable metallic stents were successfully placed fluoroscopically in 21 patients. Stents were removed 4 - 12 months [mean (5.5 ± 2.2) mouths] after placement in all patients. Stent-related complications included granulation tissue (n = 18), stent migration (n = 4), stent expectoration (n = 2), halitosis (n = 8), mucous retention (n = 21) and mucus plugging (n = 1). Granulation tissue was removed with a carbon dioxide laser in 2 patients. Stents were replaced for 2 times and 3 times respectively in 2 patients after stent migration and stent expectoration. An additional stent was placed in 2 patients after stent migration. Symptom of halitosis was relieved after prolonged course of systemic antibiotics treatment in 8 patients. Symptom of mucous retention was relieved with nebulized saline and N-acetylcysteine saline inhalation. Mucous plug was expelled after severe coughing after suctioning using an aspirator in one patient. There were statistically significant differences in stricture diameter, rank of tachypnea and pulmonary function (FEV(1)) in all 21 patients before stent insertion and after stents removal. No patient has experienced recurrence during the follow-up period of 1 - 36 months [mean (23.2 ± 8.0) months]. CONCLUSION: Fully covered retrievable metallic stent may be a safe and effective in benign tracheal stenosis. Stent-related complications may be effectively managed.

[Juvenile nasopharyngeal angiofibroma: endoscopic surgery and follow-up results].

OBJECTIVE: To present the changes of surgical approaches for the resection of juvenile nasopharyngeal angiofibromas (JNA) and the follow-up results. METHODS: The clinical records of 59 patients with JNA treated under endoscope between 2002 and 2009 were reviewed retrospectively. The patients were divided into two groups: Group A (Radkowski I a-II b) and Group B (Radkowsik II c-III b). The tumor stages, feeding vessels, operating time, complications and recurrence were observed and recorded. RESULTS: There were 7 patients with stage I a, 3 patients with stage I b, 5 patients with stage II a, 6 patients with stage II b, 4 patients with stage II c, 23 patients with stage III a, 11 patients with stage III b. The average age at diagnosis in Group A (21 cases) was 23.9 years old. The average operating time was (106.0 +/- 43.7) min. The follow-up ranged from 3 months to 74 months (median 36 months) except for 3 missing cases. The average age at diagnosis in Group B (38 cases) was 16.2 years old and the average operating time was (152.9 +/- 58.0) min. The follow-up ranged from 3 months to 87 months (median 25 months) except for 5 missing cases. During follow-up, 6 patients in group B recurred. Infarction of thalamencephalon happened in 1 patient in group B who recovered totally afterwards. The difference in operating time between two groups was statistically significant (t = -3.232, P = 0.002). The life table was used to evaluate the survival curves and Log-rank test showed that the difference of recurrent time between two groups was statistically significant (P = 0.03). CONCLUSIONS: The key techniques to remove tumor are bleeding control, drilling-out the bone that tumor invaded. Transpterygoid or posterolateral wall of maxillary sinus approach are recommended for tumors that extend to infratemporal fossa. Small and intermediate-sized JNA which have no deep invasion of skull base (RadkowskiIa-II b) have a low morbidity. JNA at Radkowski stage IIc and above have residual and recurrent risk.

[Analysis of prognostic factors in endoscopic surgery for juvenile nasopharyngeal angiofibroma].

OBJECTIVE: Analyzing the prognostic factors in endoscopic surgery of juvenile nasopharyngeal angiofibromas (JNA). METHOD: Forty-seven records of JNA, treated with the endoscopic, from 2002 to 2008 were reviewed retrospectively. Previous surgery in other hospitals, sites involved, whether selective embolization was performed before surgery, feeding vessels, operative techniques and follow-up results were recorded. Evaluated factors include previous surgery for resection of JNA, vascular supply from carotid artery, surgery after selective embolization, involvement of cavernous bone in the root of pterygoid process, greater wing of sphenoid bone, interpterygoid fossa, infratemporal fossa and orbit. Chi-square test was used. RESULT: Operations were done under general anesthesia. The follow-up time was 12 to 87 month (median 35 month). During follow up, six patients presented recurrent lesions. Chi-square test showed that deep invasion of the cavernous bone in the root of pterygoid process was related to recurrence (P<0.05). There was no statistically significant difference between other factors and recurrence. Imaging examination showed that recurrent tumor was around the root of pterygoid process. CONCLUSION: Deep invasion of the cavernous bone in the root of pterygoid process which was related to recurrence deserve close attention before and after endoscopic surgery.