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

Abstract

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.

Glomangiopericytoma (sinonasal-type haemangiopericytoma)

“…However, the majority of authors advocate angiography in larger tumours, in order not only to facilitate pre-operative planning but also to enable embolisation, which in turn significantly reduces the risk of intraoperative haemorrhage. 8,10,12 Stout and Murray were the first to describe haemangiopericytoma, in 1942, as vascular soft tissue tumours of presumed pericytic origin. 4,10 The histological features of haemangiopericytoma consist of uniform, spindle-shaped cells with indistinct cytoplasm and large nuclei, distributed around vascular channels which typically exhibit a stag horn branching pattern.…”

“…8,10,12 Stout and Murray were the first to describe haemangiopericytoma, in 1942, as vascular soft tissue tumours of presumed pericytic origin. 4,10 The histological features of haemangiopericytoma consist of uniform, spindle-shaped cells with indistinct cytoplasm and large nuclei, distributed around vascular channels which typically exhibit a stag horn branching pattern. 12 The vascular channels are often more readily defined following reticulin staining, which clearly demonstrates the proliferation of tumour cells outside the vascular sheath.…”

“…2 However, the overwhelming weight of opinion supports the principles of an 'oncological plane' and en bloc excision with clear margins, in order to reduce the potential for recurrence, as these neoplasms are relatively radioresistant. 8,10,12 Traditionally, this has been achieved through a variety of approaches, including craniofacial resection (considered to be the 'gold standard'), lateral rhinotomy and mid-facial degloving, all of which are associated with significant morbidity and major complications in up to 40 per cent of cases. 2,8,9 Endoscopic surgery of the nasal cavity and paranasal sinuses has evolved to the extent that it is now the preferred means of treatment for both benign and malignant neoplasms of the nasal cavity as well as the anterior skull base.…”

Endoscopic management of sinonasal hemangiopericytoma: case report and literature review

“…Some authors state that the presentation of hemangiopericytoma at the sinonasal level is less aggressive but locally recurrent. (6,8). The treatment of choice is endoscopic surgical resection with free margins, with positive margins being the main positive predictive factor for recurrence of hemangiopericytoma.…”

“…MRI shows sinonasal hemangiopericytoma as a solid mass with isotense signals on contrast-enhanced T1 imaging, which is useful for differentiating it from inflammatory fluid caused by sinus obstruction. (6) Imaging evaluation allows the characterization of tumor extension and its relation with adjacent structures, namely, intracranial and intraorbital components. (5) MRI is superior to CT mainly for the assessment of tumor relation with vascular structures, being important for surgical planning.…”