PMC3659647_01
Endoscopic view of the operational field before surgery (a). After embolization, shrinking is clearly seen (b). Nasal septum (S), concha inferior (CI), concha media (CM), sphenoid sinus (SS), and tumor (*).
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fig1
Head and neck examination revealed a polypoid mass obstructing the right nasal cavity subtotally (Figure 1(a)). As the biopsy was followed by a prolonged bleeding and as the radiologic findings confirmed the high vascularisation of the mass, the right maxillary artery as the main vascular feeder was selectively embolised with an ethylene vinyl alcohol dissolved in the organic solvent dimethyl sulfoxide (Onyx) 24 hours before surgery (Figures 1(b) and 3).
Radiologic findings of sinonasal hemangiopericytoma. CT scan (a), MRI scan (b), and MRI angiography (c). A circumscribed, submucosal, heterogeneous soft-tissue mass measuring 5 x 2.4 x 4.5 cm involving the right dorsal nasal cavity, the right ethmoid, and sphenoid sinus as well as the nasopharynx. A strong enhancement was seen after intravenous contrast administration (*tumor).
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A CT scan of the paranasal sinuses revealed a soft-tissue mass involving the right dorsal nasal cavity, the right ethmoid, and the sphenoid sinus as well the nasopharynx (Figure 2(a)). The MRI confirmed a circumscribed, submucosal, heterogeneous mass measuring 5 x 2.4 x 4.5 cm, extending from the cribriform plate to the platinum durum, infiltrating the ethmoidal cells and the right maxillary and sphenoid sinus (Figure 2(b)). Conventional digital angiography through the right external iliacal artery revealed a vascular network of the mass, mainly supplied by the right maxillary artery, as also seen in MRI angiography (Figure 2(c)).
Endoscopically controlled resection. Operation started as a common functional endoscopic sinus surgery including clearing out the ethmoid cells and identifying the frontal sinus and the maxillary sinus. Upon resection of the dorsal part of the septum, a pedicled tumor insertion at the rhinobasis and the lateral nasal wall was found. The tumor's feeder vessels were exhibited. The vessels originating from the arteria sphenopalatine were specifically identified and clipped ((a), (b);  ). The tumor was completely resected using four hands technique ((c), (d)). Maxillary sinus (SM), sphenoid sinus (SS), and tumor (*).
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Upon resection of the dorsal part of the septum, a pedicled tumor insertion at the rhinobasis was exhibited in four hands technique and resected completely without any complication (Figure 4).
Endoscopic view of the operation field 3 months after surgery (a). No sign of recurrence. Twelve months after surgery (b), there is no sign of irritation. Concha inferior (CI), concha media (CM), and sphenoid sinus (SS).
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One year after surgery, there was no sign of locoregional disease recurrence, neither by endoscopy (Figures 5(a) and 5(b)) nor by MRI (Figures 6(a) and 6(b)).
MRI (a) and MRI angiography (b) 12 months after surgery. The right nasal cavity appears to be free without any signs of tumor recurrence or residual.
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One year after surgery, there was no sign of locoregional disease recurrence, neither by endoscopy (Figures 5(a) and 5(b)) nor by MRI (Figures 6(a) and 6(b)).