Direct Tumor Embolization of Sinonasal Unclassified Spindle Cell Sarcoma with Onyx

Overview

Journal J Neurol Surg Rep

Publisher Thieme

Date 2016 Sep 22

PMID 27652195

Authors

Ankit Kansal

Prateek Srinet

Richard Peter Manes

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the use of a new tumor embolization agent, Onyx (Covidien, Dublin, Ireland), for the use of intraoperative embolization of a sinonasal unclassified spindle cell sarcoma.

Methods: A 45-year-old female patient presented to the rhinology clinic with a nasal mass. A biopsy revealed a highly vascular mass consistent with a sinonasal unclassified spindle cell sarcoma. Secondary to its extensive vascularity, the patient underwent preoperative transarterial embolization (TAE) before definitive resection. Due to complex vascular anatomy including feeding vessels emanating from intracranial circulation, incomplete embolization was achieved. Subsequently, intraoperative embolization with Onyx at the time of resection was performed.

Results: Intraoperative Onyx use resulted in almost complete devascularization of the tumor with decreased risk of intracranial embolization.

Conclusions: Intraoperative embolization with Onyx after an incomplete TAE can be a safe and effective method of achieving near-total embolization of sinonasal tumors.

References

Li J, Qian J, Shan X, Wang L . Evaluation of the effectiveness of preoperative embolization in surgery for nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol. 1998; 255(8):430-2. DOI: 10.1007/s004050050092. View

Aziz-Sultan M, Moftakhar R, Wolfe S, Elhammady M, Herman B, Farhat H . Endoscopically assisted intratumoral embolization of juvenile nasopharyngeal angiofibroma using Onyx. J Neurosurg Pediatr. 2011; 7(6):600-3. DOI: 10.3171/2011.2.PEDS09442. View

Gullane P, Davidson J, ODwyer T, Forte V . Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope. 1992; 102(8):928-33. DOI: 10.1288/00005537-199208000-00014. View

Tranbahuy P, Borsik M, Herman P, Wassef M, Casasco A . Direct intratumoral embolization of juvenile angiofibroma. Am J Otolaryngol. 1994; 15(6):429-35. DOI: 10.1016/0196-0709(94)90084-1. View

Chaloupka J, Mangla S, Huddle D, Roth T, Mitra S, Ross D . Evolving experience with direct puncture therapeutic embolization for adjunctive and palliative management of head and neck hypervascular neoplasms. Laryngoscope. 1999; 109(11):1864-72. DOI: 10.1097/00005537-199911000-00028. View

Lehmann M, Ulrich S, Reineke U, Hamberger U, Dietrich U, Sudhoff H . [Intratumoral Onyx embolisation in the management of juvenile nasopharyngeal angiofibroma]. HNO. 2010; 58(8):853-7. DOI: 10.1007/s00106-010-2146-2. View

Gemmete J, Patel S, Pandey A, Sullivan S, McKean E, Marentette L . Preliminary experience with the percutaneous embolization of juvenile angiofibromas using only ethylene-vinyl alcohol copolymer (Onyx) for preoperative devascularization prior to surgical resection. AJNR Am J Neuroradiol. 2012; 33(9):1669-75. PMC: 7964766. DOI: 10.3174/ajnr.A3043. View

Casasco A, Houdart E, Biondi A, Jhaveri H, Herbreteau D, Aymard A . Major complications of percutaneous embolization of skull-base tumors. AJNR Am J Neuroradiol. 1999; 20(1):179-81. View

Elhammady M, Johnson J, Peterson E, Aziz-Sultan M . Preoperative embolization of juvenile nasopharyngeal angiofibromas: transarterial versus direct tumoral puncture. World Neurosurg. 2011; 76(3-4):328-34. DOI: 10.1016/j.wneu.2010.11.011. View

10.

Lewis J, Oliveira A, Nascimento A, Schembri-Wismayer D, Moore E, Olsen K . Low-grade sinonasal sarcoma with neural and myogenic features: a clinicopathologic analysis of 28 cases. Am J Surg Pathol. 2012; 36(4):517-25. DOI: 10.1097/PAS.0b013e3182426886. View

11.

Ledderose G, Gellrich D, Holtmannspotter M, Leunig A . Endoscopic Resection of Sinonasal Hemangiopericytoma following Preoperative Embolisation: A Case Report and Literature Review. Case Rep Otolaryngol. 2013; 2013:796713. PMC: 3659647. DOI: 10.1155/2013/796713. View