2025 Poster Presentations
P370: COMBINED DIRECT TUMORAL PUNCTURE EMBOLIZATION WITH ONYX AND TRANSARTERIAL EMBOLIZATION FOR SINONASAL AND SKULL BASE TUMORS
K Al-Mulki1; M Chaskes2; C Tong2; D Golub2; E Dowlati2; A Dehdashti2; A Patsalides2; J Fastenberg2; 1Montefiore / Einstein; 2Northwell
Background: Vascular tumors of the sinonasal cavity and skull base can be surgically challenging to resect due blood loss, limited visualization, and limited access. Combined trans-arterial embolization (TAE) with direct puncture embolization (DPE) with Onyx is an effective tandem technique that has the potential to limit blood loss and facilitate the safe resection of such tumors.
Methods: Seven patients presented to an academic tertiary care center with vascular tumors. This included six with juvenile nasopharyngeal fibroma (JNA) and one with renal cell metastasis to the sinonasal cavity. All patients were treated with combined DPE and TAE, followed by endoscopic surgical resection within 48 hours. Patient and operative data were reviewed.
Results: All patients presented with epistaxis as their primary compliant prior to diagnosis. JNA tumors included in this study were Radkowski grade IIa (2), IIb (2), or IIc (2). One tumor was a renal cell carcinoma metastasis to the sinonasal cavity. The largest AP dimension among all tumors was 86mm (range 37-86mm). The average amount of Onyx injected into each tumor was 15.1 mL (range 3-33 mL). Average estimated blood loss was 380 mL (range 60-700 mL). All patients underwent coil embolization of the internal maxillary artery, and the renal cell carcinoma patient underwent coil embolization of the facial in addition to the internal maxillary artery. There were no direct tumor puncture or embolization related complications in any patient. Surveillance MRI and physical exam have showed no evidence of recurrence in any patient to date.
Conclusions: Pre-operative devascularization with TAE and onyx DPE is a safe and effective tandem technique for vascular sinonasal tumors, and it may facilitate dissection. Surgeons should consider use of this tandem technique prior to resection of not only vascular tumors such as JNA, but also malignant tumors s in which excessive blood loss is anticipated.