Multiple strategies to avoid life-threatening blood loss during intralesional resection of a giant Plexiform Neurofibroma: A case report

@#Giant plexiform neurofibroma (PNs) are benign peripheral nerve sheath tumors known to contain multiple fascicles of nerve and numerous friable vascular components. Most consult due to significant disfigurement and functional deficit. Though surgery is the current standard of therapy, there is high reservation in pushing through with resection in most cases. The reservation stems from the recognized difficulty in controlling intraoperative life-threatening hemorrhage. A 25-year-old female came in our institution due to multiple debilitating giant PNs on her scalp, back, neck, shoulder, and chest. She opted for debulking surgery despite possible complications and recurrence. Multiple modalities used to prevent massive bleeding in this case included preoperative arterial embolization, energy sealing device, cutting linear stapler, and interlocking retention sutures. The aim of this case report was to discuss the utility of each of these techniques, the advantages and disadvantages of each approach based on our experience.

8 Cases of Nasopharyngeal Angiofibromas / 대한이비인후과학회지

INTRODUCTION: Nasopharyngeal angiofibroma is a rare histologically benign tumor which occurs almost exclusively in adolescent boys. The morbidity and mortality associated with this tumor are related to its prominent vascularity and its propensity for aggresive local growth. MATERIALS AND METHOD: From November 1990 through February 1996, 8 patients with a diagnosis of nasopharyngeal angiofibroma were managed at Asan Medical Center. For the devasculation of the tumor before the surgery, preoperative arterial embolization was performed on 6 patients. RESULTS: The main tumor supplying vessel was ipsilateral internal maxillary artery in all cases. According to Chandler classfication(Table 1), stage II was 4 cases and stage III was 4 cases. Operative procedures were midfacial degloving approach(4 cases), transpalatal approach(1 case), transantral approach(1 case), combined approach(1 case: Caldwell-Luc op & endoscopic op), medial maxillectomy(1 case). There were no treatment-related deaths and no major surgical complications.