{

initial surgical resection provided easier

resection of the tumor from peripheral tissue
than would repeated surgical resection.
Although this primary tumor was very large,
the intraoperative blood loss was only 100 ml
a tumor extending widely into the anterior
and middle cranial fossae, but leaving the
dura mater intact, was removed completely
with limited blood loss.
excision of a recurrent tumor resulted in more
intraoperative blood loss compared with
primary tumor removal due to the difficulty of
separating the tumor from peripheral scar
tissue and blood vessels
 a recurrent tumor with wide extension into
the middle cranial fossa was difficult to fully
excise
 One case of epidural hematoma
occurred secondary to pyogenic
epidural abscess.

One case of excessive bleeding led

to disseminated intravascular
coagulation.

Complications
 Type I tumors should be resected using an intranasal
endoscopic approach

Type II tumors can be removed by a transantral

infratemporal fossanasal cavity combined approach via
an extended CaldwellLuc incision. The advantages of
this approach are obvious and reliable. Moreover, an
extended CaldwellLuc incision can avoid facial scarring
and provides a wider surgical field

Type III tumors require the use of an intracranial and

extracranial combined approach, and radiotherapy
should be initiated if residual tumor is present in the
middle cranial fossa.

Discussion
 most feeding arteries originate from the internal maxillary artery and the ascending
pharyngeal artery, and occasionally from the middle menin- geal artery of the ipsilateral
ECA

A large JNA is often supplied by the contralateral ECA

Tumors that extend widely into the middle cranial fossa are often supplied by branches of
the cavernous segment of the ICA, ophthalmic artery, and middle cerebral artery. Because
these small arterial branches cannot be embolized, serious intraoperative blood loss may
result in tumor recurrence

In patients who have undergone an initial operation, the tumor usually adheres to the
surrounding blood vessels, such as the pterygoid venous plexus or sphenopalatine vein.

Blood loss and tumor

recurrence
 The classification of JNAs into three types is relatively simple and clear

The endoscopically guided nasal cavity approach can used to remove a type I JNA

The transantral infratemporal fossanasal cavity combined approach via an

extended CaldwellLuc incision is suitable for the removal of a type II JNA

If the tumor is calabash-like and extends deeply into the middle cranial fossa, full
removal can be difficult, and any intracranial tumor remnants should be treated with
40- Gy radiotherapy

Regardless of tumor size, after DSA- guided embolization of ECA blood-supplying

branches, the operation should be performed under direct visualization, the tumor
should be carefully resected, and bleeding of the ICA and the pedicle vein plays a
crucial role in determining surgical success and avoiding recurrence

Conclusions