Endoscopic resection of nasal haemangiopericytoma

Endoscopic Excision of Sino Nasal Hemangiopericytoma

Hemangiopericytomas (HPCs) are rare vascular tumours originating from extra capillary cells called Zimmermann's pericytes. Only 5% of these lesions occur in the Sino nasal cavity. Sino nasal HPCs have a benign course with a high recurrence rate ranging from 9.5 to 50%. A radical surgical resection is considered the gold standard treatment either via external approach (lateral rhinotomy or Caldwell-Luc) or endoscopic approach. Three cases of Sino nasal hemangiopericytomas were treated at our institute. All these cases were operated via endoscopic approach. We are reporting their diagnostic work-up and the therapeutic management as case series. We also discuss epidemiological, clinical, morpho-pathological and radiological characteristics of this tumoral pathology. A treatment plan is also elucidated which may help to develop a long term treatment protocol for these lesions.

Navigation-assisted endoscopic endonasal surgery of a glomangiopericytoma with intraorbital extension: A case report and literature review

A glomangiopericytoma, or sinonasal type hemangiopericytoma, is a rare lesion which accounts for <0.5% of all sinonasal tumors. The mainstay treatment is wide excision. Instead of traditional open surgical approaches, such as midfacial degloving or lateral rhinotomy, we offer a case of 21-year-old male with diagnosis of glomangiopericytoma with skull base and intraorbital invasion and received navigation-assisted endoscopic excision of a glomangiopericytoma.

Endoscopic Resection of Sinonasal Hemangiopericytoma following Preoperative Embolisation: A Case Report and Literature Review

Objectives. Hemangiopericytoma is a rare tumor entity deriving from pericytes. Less than 5% of hemangiopericytoma occur in the nasal cavity and are characterised by a rather benign nature with low tendency of metastasis. However, as the recurrence rate in the literature ranges from 9.5% to 50%—depending on the length of followup—a radical surgical resection is considered as the gold-standard treatment. Only a few years ago, a wide external approach, usually via lateral rhinotomy or Caldwell-Luc, was performed. Endoscopic techniques were regarded as appropriate for small low-vascularised tumors only. Methods. We present the case of a 64-year-old patient with an extended sinonasal hemangiopericytoma, who was successfully treated by an endoscopic controlled endonasal tumor resection after embolisation with Onyx. Further, to support the new treatment option, we review the literature concerning all features of sinonasal hemangiopericytomas and their therapeutical management. Results/Conclusion. Onyx, which has not been described in the context of hemangiopericytoma yet, is a very effective embolic agent for a preoperative embolisation of sinonasal hemangiopericytoma allowing a safe endoscopic surgery.

Management of sinonasal hemangiopericytomas: a systematic review

BACKGROUND

Hemangiopericytomas are typically found in soft-tissue, but only rarely found in the sinonasal tract. Sinonasal hemangiopericytomas have been reported mostly through case studies, and optimal treatment is considered surgical excision. Classically, open surgical methods of tumor extirpation have been considered standard of care. With the wider use of endoscopic methods, an updated systematic review in terms of treatment is warranted.

METHODS

Cases were identified using a MEDLINE and PubMed search. Relevant studies were identified, and data was extracted regarding patient demographics, presenting symptoms, tumor characteristics, treatment, and outcomes.

RESULTS

A total of 128 cases were collected from 56 articles, consisting of case reports and series. The most common presenting symptoms were epistaxis, nasal obstruction, and facial pain/swelling/pressure. Computed tomography (CT) and X-ray were the most common modes of imaging during diagnosis and operative planning. The tumor often occupied multiple locations in the sinonasal tract at initial presentation. Surgical resection was the mainstay of treatment in 126 of the 128 cases (98.4%), either through open resection or endoscopic techniques. Surgical removal resulted in no recurrence in 79.7% of the cases. The use of endoscopic techniques increased significantly in the past decade. This review found no significant difference in terms of recurrence between endoscopic and open treatment groups, age, gender, and unilocality vs multilocality of tumor.

CONCLUSION

Surgical management remains the mainstay of treatment for hemangiopericytomas. Endoscopic resection of these lesions has increased over the last few decades and has become a safe, viable, and reasonable alternative to open resection.

Systematic review of treatment and prognosis of sinonasal hemangiopericytoma

BACKGROUND

This study was undertaken to determine the recurrence rate for open and endoscopic surgery and the clinical prognosis of this sinonasal tumor.

METHODS

A systematic review of individual cases of sinonasal hemangiopericytoma was performed. A total of 97 articles were included in the study and reviewed to extract the relevant information about each case.

RESULTS

In all, 194 cases of sinonasal hemangiopericytoma were identified. There were 53 recurrences (27.3%), 6 tumor-related deaths (3.1%), and 4 cases of metastases (2.1%). There was no significant difference between rate of recurrence for endoscopic or open resection (p = .06). Incomplete excision was the most important predictor of recurrence (odds ratio = 11.50, 95% confidence interval 3.76-36.82, p < .001). Radiotherapy may be advantageous in cases of incomplete surgical resection (p = .03).

CONCLUSIONS

Complete excision is essential to minimize tumor recurrence and radiotherapy may decrease the rate of recurrence in the case of incomplete resection. Current evidence does not suggest that open resection is superior to endoscopic resection.

Endoscopic skull base surgery for sinonasal malignancy

Management of malignant neoplasms of the sinonasal tract and skull base is hampered by the relative low incidence and pathologic diversity of patient presentations. Many studies have reported successful outcomes in the endoscopic management of malignancy since 1996, and these are summarized in this article. Nonsurgical adjuvant therapies are important for locoregional control because surgery occurs in a restricted anatomic space with close margins to critical structures, and distant disease is an ongoing concern in these disorders. There remains a need for collaborative consistent multicenter reporting, and international registries have been established to assist in such efforts.

Endoscopic, endonasal management of sinonasal haemangiopericytoma: 12-year experience

AIM

To report our experience with endoscopic, endonasal management of sinonasal haemangiopericytoma.

MATERIALS AND METHODS

Retrospective review of the medical records of 10 patients undergoing endoscopic, endonasal surgery for sinonasal haemangiopericytoma of the nose and paranasal sinuses, between 1997 and 2008.

RESULTS

Five men and five women were included. Their mean age at surgery was 59 years. All patients underwent endoscopic, endonasal resection of their tumour. Major post-operative complications were encountered in only one patient (stroke). Local recurrence was diagnosed in only one patient (10 per cent), who subsequently underwent a combined resection (endoscopic and external) with orbital exenteration.

CONCLUSIONS

Sinonasal haemangiopericytomas are rare tumours that are usually benign. The mainstay of treatment is wide surgical excision with free resection margins. Nowadays, the great majority of patients can be treated using a purely endoscopic, endonasal approach.

Endoscopic sinus surgery for the treatment of vascular tumors

BACKGROUND

This study points out the effectiveness of the endoscopic approach for the treatment of vascular lesions such as angiofibroma, hemangioma, and hemangiopericytoma involving the nose and paranasal sinuses.

METHODS

We performed a retrospective study at an academic tertiary referral center. Thirteen patients, diagnosed with vascular tumors of the nose and paranasal sinuses were treated endoscopically between February 1996 and July 2003. All patients underwent endonasal endoscopic surgery. Preoperative angiography with embolization was performed in all but two cases.

RESULTS

The follow-up of this series varied from 6 to 75 months (mean, 23 months); only one recurrence (8%) was observed in the juvenile angiofibroma group encountered 20 months postoperatively. This recurrence was again treated endoscopically. The average intraoperative blood loss for the removal of the juvenile angiofibroma group was 300 mL and it was 100 mL for the other vascular tumors.

CONCLUSION

Endoscopic treatment alone is an effective approach for the removal of selected cases of vascular tumors. Even in the presence of a lesion with limited intracranial extension, the tumor still may be amenable to an endoscopic approach alone. On the contrary, this is not true if the intracranial extension receives feeding vessels from the internal carotid arterial system.

Endoscopic Resection of Sinonasal Hemangiomas and Hemangiopericytomas

INTRODUCTION

Endoscopic resection of benign neoplasms, such as inverted papilloma, has been well described. There are limited case reports of endoscopic resection of benign vascular tumors, including hemangiomas, or those with low-grade malignant potential, such as hemangiopericytomas.

METHODS

Retrospective review of sinonasal hemangiomas and hemangiopericytomas resected endoscopically at a single tertiary-care facility.

RESULTS

Three hemangiomas and 3 hemangiopericytomas were resected endoscopically with no recurrences at a mean follow-up of 22 months. Four tumors involved the skull base; 2 of these underwent preoperative embolization. One patient had a CSF leak that occurred as the tumor was removed from the cribriform plate and that was successfully repaired intraoperatively. The average size of the tumors was 5.8 cm x 2.7 cm with all tumors at least 2.5 cm in greatest dimension by computed tomography or magnetic resonance imaging. The largest tumor was 12 cm in greatest dimension. An average of 8 intraoperative frozen section margins was taken around 5 tumors, with all margins of each tumor clear on final pathology. Patients included 4 males and 2 females with an average age of 47 years.

CONCLUSION

Large vascular neoplasms of the sinonasal cavity, such as hemangiomas and hemangiopericytomas, can be safely removed using endoscopic techniques. Although these patients have a limited follow-up, it is prudent to perform long-term endoscopic follow-up in order to detect recurrences regardless of resection technique.

Endoscopic sinus surgery for benign and malignant nasal and sinus neoplasm

PURPOSE OF REVIEW

Endoscopic sinus surgery has become widely accepted as the standard of treatment for chronic inflammatory diseases of the paranasal sinuses unresponsive to medical treatment. With increased skill with endoscopic surgical technique, advanced technologies such as intraoperative imaging systems, and a better understanding of the complex anatomy of the paranasal sinuses and surrounding vital structures, many otolaryngologists have increasingly applied their expertise in endoscopic sinus surgery to the resection of nasal and sinus neoplasms. The following represents a review of the recent literature on the latest trends regarding endoscopic resection of nasal and paranasal sinus neoplasms.

RECENT FINDINGS

There has been an increasing popularity in the removal of nasal and paranasal sinus neoplasms through an endoscopic approach. In the recent literature, emphasis has been on the endoscopic surgery of benign tumors, especially inverted papilloma and nasopharyngeal angiofibroma. Other benign neoplasms have also been reported, but only in small case reports. There have been a few recent reports supporting endoscopic removal of malignant neoplasms as well. However, the follow-up is too short and study groups too small to make definitive conclusions.

SUMMARY

In the hand of experienced and skilled surgeons, complete endoscopic removal is attainable in most cases. Especially for the more common benign neoplasms, such as inverted papilloma and early stage angiofibroma. En bloc resection is not necessary to achieve oncologic cure. However, several factors have to be considered before selection of this surgical approach. Large tumor size, intracranial or orbital extension, and extensive frontal or infratemporal fossa involvement are relative, but not absolute limitations.

Sinonasal haemangiopericytoma: a case report

Haemangiopericytoma (HPC) is a rare vascular tumour that is thought to originate from the vascular pericytes of Zimmerman. HPC may arise in any part of the body, and from 15 to 30% of these tumours are found in the head and neck, with a rare involvement of the sinonasal region The main symptoms of nasal HPC, epistaxis and nasal obstruction, are not typical. The final diagnosis is based on the histopathology and immunochemistry, and whether the tumour is benign or malignant is defined on the basis of the clinical history. HPC located in the sinonasal area is generally benign. We report the case of a young woman with a sinonasal mass histologically proven to be haemangiopericytoma. The patient underwent surgical treatment by means of mid-facial degloving after embolisation of the maxillary artery. After a careful 3-year follow-up, the patient is disease free and healthy.