Endoscopic Nonembolized Resection of an Extensive Sinonasal Cavernous Hemangioma: A Case Report and Literature Review

Abstract

Sinonasal hemangiomas, although rare, must be considered in the evaluation of intranasal masses with profuse epistaxis. Although the availability of literature discussing cavernous hemangiomas in this location is limited, there have been no case reports of exclusively soft tissue sinonasal cavernous hemangiomas extending to the anterior skull base (ASB) that were resected purely endoscopically. Here, we describe the successful endoscopic resection of an extensive right sinonasal cavernous hemangioma extending to but not invading the ASB. Although highly vascular, in select cases, these tumors can be successfully resected endoscopically without embolization by experienced endoscopic sinus and skull base surgeons.

Endoscopic resection of large endonasal hemangioma: Case report

“…Hemangiomas are the most common vascular malformations of the head and neck [ 1 , [3] , [4] , [5] , [6] , [7] ]. They develop from a hamartomatous proliferation of vascular endothelial cells [ 1 , 5 ]. Hemangiomas can grow from mucosal, submucosal or osseous tissues of the nasal cavity or sinuses [ 6 ].…”

“…Hemangiomas are common benign vascular tumors of the head and neck region [ 1 , [3] , [4] , [5] , [6] , [7] ]. However, it is uncommon for them to arise in the paranasal sinus mucosal tissues [ [3] , [4] , [5] , [6] , [7] ]. They represent only 10% of head and neck tumors and 25% of non-epithelial sinonasal neoplasms [ 2 ].…”

“…They represent only 10% of head and neck tumors and 25% of non-epithelial sinonasal neoplasms [ 2 ]. It is difficult to distinguish hemangiomas from other expansible maxillary sinus lesions due to their non-specific early clinical presentation, along with non-specific imaging findings [ 4 , 5 , 7 ].…”

“…Hemangiomas growing in the sinonasal cavity are very unusual [ [3] , [4] , [5] ]. However, the lesions are often benign in nature [ 1 , 4 , 5 ].…”

“…Hemangiomas growing in the sinonasal cavity are very unusual [ [3] , [4] , [5] ]. However, the lesions are often benign in nature [ 1 , 4 , 5 ]. In practice, small hemangiomas are usually resected through functional endoscopic sinus surgery (FESS), while the larger ones are excised by open surgery for adequate exposure, control of bleeding and wide margin resection [ 1 , [3] , [4] , [5] , [6] , [7] ].…”