Endoscopic Endonasal Transpterygoid Nasopharyngectomy

Objective: To describe our technique for endoscopic transpterygoid nasopharyngectomy and support its effectiveness with our early clinical outcomes.

Methods: Our endoscopic endonasal technique comprises an extended inferomedial maxillectomy, mobilization of the pterygopalatine fossa, and removal of the pterygoid plates and Eustachian tube to access the posterolateral nasopharynx. Control of the para-pharyngeal and petrous segments of the internal carotid artery is the keystone of the approach.

Results: Various histopathologies were treated, including epidermoid carcinomas (N = 9), lymphoepithelioma (N = 1), adenoid cystic carcinoma (N = 7), adenocarcinoma (N = 2), mucoepidermoid carcinoma (N = 2), and sarcoma (N = 1). Negative microscopic margins were obtained in 86% (19/22) of patients. No perioperative mortality, cerebrospinal fluid (CSF) leak, meningitis, or cerebrovascular accident was encountered; however, one patient suffered an internal carotid artery (ICA) injury that was controlled without permanent sequelae. All but one patient received adjuvant therapy (IMRT, proton and/or stereotactic radiotherapy with or without chemotherapy). Follow-up ranged from 12 to 78 months (mean = 36 months). Overall survival was 59% (13/22), and local control was 68% (15/22).

Conclusions: Endoscopic transpterygoid nasopharyngectomy for primary and recurrent nasopharyngeal malignancies is feasible and safe in properly selected patients. Our preliminary outcomes compare to that of conventional techniques. Endoscopic resections, however, are demanding; they require specialized equipment and a team versed in endoscopic oncologic surgery. Long-term follow-up and reproducibility remain undefined.