2015 HSC Section 1 Book of Articles

TABLE VII. Aggregate Patient Data Cohort of Studies Comparing Endoscopic, Endoscopic-Assisted, and Open Surgery Groups.

All Aggregate Data

Total Patients

ES Patients

ES Recurrence

ES % Recurrence

EA Patients

EA Recurrence

EA % Recurrence

OS Patients

OS Recurrence

OS % Recurrence Follow-up

Study

Year

Ye

2011 23 2011 12 2011 20 2011 4 2011 29 2011 42 2010 16 2009 42 2009 7 2009 19 2009 31 2009 18 2008 85 2007 12 2006 8 2005 58 2003 7 2002 20 2002 5 2001 33 2001 39 1999 14 1998 20 1996 36 1996 23 2005 37

23

0

0.0

0

— — 0 — — 12

— — 58.0

Singh Mattei

0 0 4 0

— — 0 — — 20

0

0.0

12.0

3

15.0% 0

— — 60.0 — — 11.3

Herman

0

0.0

0

— — 0 — — 29 — — 29 — — 23 — — 30 — — 7 — — 0 — — 8 — — 85 — — 0 — — 0 — — 53 — — 37 — — 19 — — 0 — — 0 — — 5 — — 33 — — 39 — — 14 — — 20 — — 36 — — 23 1 50.0% 12 3 25.0% 4

Cherekaev

— — 0

5 9 6 4 7 0

17.2 31.0 50.0 17.4 23.3

48.0 43.4 27.6 21.0 92.0 42.0 48.0 24.4 54.9

Bosraty Gaillard

13

3 0

23.1

0 2

2 0

0.0

Elsharkawy 2010 23

— — 0

Midilli

12

0

0.0

0

Margalit

0

— — 0

0.0

Huang

19 15 10

0 1 0 0 1 0

0.0 6.7 0.0

0

— — 34.0

Hackman

12

1 4

25.0 50.0 15.3

Bleier

0

Danesi

0

— — 0

13

Andrade

12

0.0

0 0 0

— — 24.0 — — 54.0

Chen Pryor

8 5

12.5

0.0

14

26.4 13.0 ES, 48.0 OS

Hosseini

0 0 7 0 0 0 0 0 0 0

— — 0 — — 0

10

27.0

46.5

de Mello-Filho 2004 19

0

0.0

116.4

Wormald

0 2

0.0

0 0

— — 45.0 — — 22.0

Roger Bales

20

10.0

— — 0 — — 0 — — 0 — — 0 — — 0 — — 0 — — 0

1 8 8 4 5

20.0 24.2 20.5 28.6 25.0 36.1 21.7 22.6

38.0 56.0 24.0 63.0 25.0 61.8 72.0

Paris

Howard

Tewfik Zhang

Ungkanont Radkowski

13

5

Total

702 150

7

4.7

34

7

20.6

518

117

—

EA ¼ endoscopic assisted group; ES ¼ endoscopic group; OS ¼ open surgery group.

8.7% and suggest that endoscopic techniques can be uti- lized even in cases of intracranial involvement. Indications for open surgical approaches may include instances when there is significant involvement of inter- nal carotid artery, cavernous sinus, or optic nerve. 27 Ardehali et al. 32 also came to similar conclusion follow- ing a study of 47 patients treated by endoscopic or endoscopic-assisted resection; recurrence rate in this cohort was 19.1%. The authors of this study similarly suggested that endoscopic approaches may be utilized in cases of minimal intracranial involvement, but cases where there is a large intracranial component should be reserved for open surgery. Drawing on their experiences with endoscopic resection, the authors recounted one case of a Radkowski stage IIIb JNA. Due to cavernous sinus injury, significant intraoperative hemorrhage occurred leading to 8,500 mL of blood loss. 32 The primary measure of success in the treatment of JNA is the recurrence rate. 16 Howard et al. 36 found that the recurrence rate was reduced from 35.0% to 0.0%

when macroscopic removal of JNA was combined with drilling out of the basisphenoid. The working hypothesis in this study was that most recurrences occur as a result of invasion of the sphenoid and incomplete excision. Lund et al. 37 put forth the concept that JNA undergoes a period of rapid growth followed by a stable phase. Therefore, the recurrence of JNA may be due to an incomplete resection during the aggressive growth phase of the JNA. 36 Recognizing this and the fact that not all studies report residual tumor separately from recur- rence, we combined residual tumor and recurrence into one category. Comparing the IPD and APD, the total recurrence rates of these series were 14.2% and 18.7%, respectively. The recurrence rates in this study are simi- lar to what has been reported in the literature. 14,18 The conflicting results between IPD and APD cohorts with respect to recurrence rate is interesting and should be commented on. IPD provides the most effective data when provided in large quantities, as it allows for com- plete and accurate analysis of outcome measures as well

Laryngoscope 123: April 2013

Boghani et al.: Systematic Review of JNA

118