Vol.99 No.12 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 99 No. 12 December 2006
A Nasal Hemangioma Resected Two
Months after the Embolization
Motoki Sekine, Masahiro Iida, Takahide Hamano,
Kenji Okami and Shinri Oda
(Tokai University School of Medicine)
Although hemangioma is a benign tumor that is generally treated surgically, preoperative treatment is often required for hemangioma in the nasal cavity or paranasal sinuses because a good visual field is difficult to achieve with heavy blood flow, increasing the risk of massive hemorrhage. Super-selective embolization is widely accepted as the treatment of choice to control hemorrhage during surgery for vascular tumors.
A 43-year-old woman complained of unilateral nasal obstruction and nasal bleeding. A hemorrhagic tumor was found in the left nasal cavity. The pathologic diagnosis was capillary hemangioma. Embolization was performed prior to surgery to minimize bleeding. Selective catheter embolization was performed with NBCA (N-butyl-2-cyanoacrylate), which was introduced into the distal branch of the sphenopalatine artery.
Radical surgery was planned for a few days after embolization, but it was postponed because Moya-Moya disease was found during angiographic study. The tumor gradually decreased in size after angiography and selective embolization of the feeding arteries. We were able to resect the tumor by the transnasal route with endoscopy 69 days after embolization. Total blood loss during the operation was 10 ml.
In general, radical surgery is performed within 1 week after preoperative embolization because a long waiting period after embolization increases the risk of recanalization and collateral vessel formation. When we use long-acting embolic material and embolize the distal branch of the feeding artery, we may be able to perform minimally invasive surgery by waiting for a longer period after embolization.
Key words :
super-selective embolization, capillary hemangioma, NBCA (N-butyl-2-cyanoacrylate),
long-acting embolic material