Fig.1

Electromagnetic navigation map of recurrent nasopharyngeal carcinoma A. The white arrow in the figure refers to the internal carotid artery in the foramen lacerum area; B. The free middle turbinate mucosal flap repairs the skull base. "

Fig.2

Resection steps and resection range of right nasopharyngeal carcinoma A. Use of a plasma knife to cut the mucosa 0.2 cm outside the tumor boundary; B. Excised nasopharyngeal mucosal tissues under a plasma knife; C. Resection of the mucosa till the bone surface; D. Grinding the pterygoid process root bone; E. The right sphenoid sinus, medial and lateral plate of the pterygoid process, foramen rotundum, and vidian canal are shown; F. Resection of the right medial and lateral plate of the pterygoid process; G. The infratemporal region tumor tissue is shown; H. Resection of the subtemporal apex; I. The nasopharynx after the tumor is completely cut is shown. "

Fig.3

Repeated hemorrhages in the nasal cavity after radical radiotherapy for nasopharyngeal carcinoma A. Internal carotid artery angiography shows left internal carotid artery pseudoaneurysm; B. After internal carotid artery coil embolization. "

Fig.4

A 62-year-old man relapsed 3 months after undergoing radiotherapy for nasopharyngeal carcinoma, and was diagnosed with poorly differentiated squamous cell carcinoma (T3N0M0). Surgical treatment was performed in May 2015 without chemotherapy nor radiotherapy, with no recurrence after 45 months of follow-up A-D. Magnetic resonance imaging (MRI) after radiotherapy and before the operation; E-H. MRI showing total tumor resection (postoperative 36 months). "

Fig.5

A 58-year-old woman with non-keratinized undifferentiated carcinoma (T1N0M0) underwent endoscopic surgery for nasopharyngeal carcinoma in August 2014 and postoperative radiotherapy 5 000 cGy/25 f with follow-up till date A-D. Preoperative magnetic resonance (MR); E-H. Postoperative 12 months MR; I-K. Postoperative 36 months MR shows no recurrence. "

Fig.6

A 38-year-old man with differentiated non-keratinized carcinoma (T3N0M0) underwent endoscopic surgical resection, postoperative radiotherapy, and chemotherapy (DT: 7 623 cGy/33 f, only 25 times; 3 675 cGy/15 f; TP: docetaxel 140 mg/dl + nedaplatin 140 mg/dl), with follow-up for 48 months A-D. Preoperative magnetic resonance (MR) shows that nasopharyngeal carcinoma tissue invaded the sphenoid sinus and saddle region, pushing up on the optic chiasm, causing impaired vision in the patient; E-H. No recurrence of nasopharyngeal carcinoma lesions seen 24 months postoperatively; I. The tumor tissue surrounding the internal carotid artery (white arrow refers to the internal carotid artery) is removed; G. The tumor tissue on the surface of the optic nerve tube is removed (white arrow refers to the optic chiasm); K. The nasopharynx shows local dryness after radiotherapy and chemotherapy; L. The nasopharynx shows less dryness during 24 months of follow-up. "

Fig.7

A 48-year-old man with local recurrence of nasopharyngeal carcinoma, 2 years after radiotherapy, refused two-way radiotherapy and underwent total endoscopic resection of the nasopharyngeal carcinoma and postoperative chemotherapy, with a 24-month follow-up A. Left nasopharyngeal parietal tumor; B. Endoscopic resection of the tumor (a. inner margin, b. outer margin, c. upper margin, d. lower margin, e. deep margin); C. Appearance of the nasopharynx, 24 months after surgery."

Fig.8

A man with nasopharyngeal carcinoma showed recurrence, skull necrosis, liquefaction necrosis in the eustachian tube area, intractable headache, mouth and nose odor (white arrow refers to the exposed internal carotid artery), 6 months after the first radical radiotherapy A-D. Preoperative nasopharyngeal magnetic resonance (MR) shows necrosis of the right nasopharynx, local liquefaction, invasion of the internal carotid artery rupture zone, and lack of bone; E-H. Postoperative nasopharyngeal MR shows clearing of the lesion."

Fig.9

A 58-year-old woman underwent radical radiotherapy for nasopharyngeal carcinoma in March 2015, and accepted chemotherapy after recurrence of nasopharyngeal resection in June 2015 without surgical treatment A-B. Lesion is controlled; C-D. August 2015; E-F. Lesion progresses in October 2015; G-H. In April 2017, nasal bleeding is controlled after conservative treatment. In August 2017, small repeated nosebleeds begin; I-J. On September 30, 2017, another episode of hemorrhage and hemorrhagic shock leads to hospital admission; K-M. The examination reveals a large area of ulceration of the left nasopharynx; The magnetic resonance image shows that the nasopharyngeal lesion eroded the left internal carotid artery. In the emergency department, internal carotid artery embolization was performed. On October 2, 2017, the patient died of hemorrhage. "