J Neurol Surg B Skull Base 2014; 75 - A005
DOI: 10.1055/s-0034-1370411

Endoscopic Endonasal Management of Sinonasal Hemangiopericytomas – A Role for Aggressive Resection

M. L. Otten 1, S. J. Singhal 1, A. M. Iloreta 1, H. G. Garcia 1, G. G. Nyquist 1, C. J. Farrell 1, J. Casey 1, M. R. Rosen 1, J. J. Evans 1
  • 1Philadelphia, USA

Introduction: Hemangiopericytomas represent a rare sinonasal tumor, and there are fewer than sixty cases in the literature managed with endoscopic endonasal approach (EEA). Deriving from perivascular, modified smooth muscle cells, this tumor poses a challenge for gross total resection. Fewer than 5% of hemangiopericytomas present in the nasal cavity. Some have argued that this is a benign process, but we hypothesize that sinonasal invasion presents a challenge for management, and recurrence is common in this tumor. We present our series of EEA to resect sinonasal hemangiopericytomas, with an outcomes analysis.

Methods: We performed a retrospective review of patients with sinonasal hemangiopericytoma, confirmed with pathologic specimen. The period reviewed was October 2003 to August 2013. Patients were included only if they had hemangiopericytoma involving the sinuses, and were resected via EEA.

Results: A total of 8 patients underwent EEA to resect sinonasal hemangiopericytoma, representing 12 cases. Five of these patients had invasion of the cranial base. The age range was 44 to 88 years (average 63 +/− 14). Nearly all (7/8) patients presented to our practice with recurrent tumor, and we obtained a gross total resection, with pathologically negative margins, on 7/8 of patients, 4 of which required re-operation. Our follow up was 2 to 58 months (average 27 +/− 20). Adjuvant radiation was done in 5 of 8 patients. Two of eight patients had post-operative CSF leak, prior to 2008, and one required re-operation – the other was managed with lumbar drainage.

Conclusions: Our results demonstrate that sinonasal hemangiopericytoma is an invasive disease that is difficult to cure. That seven of our eight patients presented with recurrence after resections were done elsewhere indicates that this disease is aggressive, and needs to be treated as such. The traditional perspective is that these are benign lesions that do not need gross total resection. Our experience supports early, aggressive resection with oncologic margins, even with reoperation to attempt at total resection.