Endoscopic surgical strategy for highly vascular pediatric sinonasal and pterygopalatine fossa tumors

Pediatric sinonasal tumors are rare, and minimally invasive approaches are preferred because of unknown long-term effects on development. We report three cases of highly vascular pediatric sinonasal and pterygopalatine fossa tumors that were successfully removed using an endonasal endoscopic approach with transcatheter arterial embolization (TAE). The patients (9–11 years old) had contrast-enhanced tumors in the left ethmoid sinus near the sphenopalatine foramen in case 1, in the right nasal cavity near the sphenopalatine foramen in case 2, and in the right pterygopalatine fossa in case 3, with diameters of 32, 50, and 61 mm, respectively. Computed tomography and magnetic resonance imaging demonstrated tumors with strong contrast enhancement and flow voids in all cases. TAE was performed in all cases on the day of surgery, followed by endoscopic sinus surgery with nasal septal modification. Pathology revealed pyogenic granuloma, nasal polyps, and juvenile angiofibroma. After TAE, tumor reduction improved visualization in case 1. Nasal septum manipulation enabled medial traction and tumor base identification in cases 2 and 3. The combination of preoperative TAE and septal modification proved effective for achieving complete endoscopic tumor removal. No complications occurred, and follow-up at 1–1.5 years showed no tumor recurrence or developmental abnormalities.