A.S. Lopatii, I.I. Akulich, G.Z. Piskunov, D.N. Kapitanov, P.A. Kochetkov Medical Center of the Presidential Administration of the Russian Federation, N.N. Burdenko Neurosurgery Research Institute of the Russian Academy of Medical Sciences, I.M. Sechenov Moscow Medical Academy Moscow, Russia Vascular tumors of the nose and paranasal sinuses (ONS), even benign in their histological structure, are capable of destroying surrounding bone and cartilage structures, spreading into the orbit and cranial cavity (V.A. Cherekaev, 1995). The endonasal method of removing such tumors is rarely used, only for the removal of small tumors located in the anterior parts of the nasal cavity. For larger tumors, the Denker approach, Moore lateral rhinotomy, and sometimes a transcranial approach are usually used. Preliminary recommendations include ligation of the external carotid artery or endovascular embolization of the vessels feeding the tumor. In recent years, the first reports have appeared in the literature on the possibility of intranasal endoscopic removal of large vascular tumors (in particular, hemangiopericytomas) of the NPP. In the series presented by S. Herve et al. (1999), the endoscopic approach was supplemented by an external one in two of four cases. E. Serrano et al. (2000) followed the results of endoscopic removal of five hemangiopericytomas with preoperative vascular embolization; only one patient developed a relapse within 4.5 years. Between 1997 and 2004, we operated on 14 patients with large vascular tumors of the NPP using only the endonasal approach. The average age of the patients operated was 43 years. According to the histological structure of the tumors, they were distributed as follows: capillary hemangioma - 9 patients, cavernous hemangioma - 4; hemangioendothelioma - 1, while in 10 cases the histological diagnosis was verified only after surgery. In the remaining 4 cases, the diagnosis was made after a preliminary biopsy. All these tumors reached stage III and were accompanied by severe nosebleeds. The tumor was limited to the nasal cavity in 6 cases; it extended from the nasal cavity to the ethmoid labyrinth in two patients, to the maxillary sinus in one patient, to the choana in one patient and to the sphenoid sinus in another patient. In two cases, the tumor was located in the maxillary sinus, and in one case it occupied the ethmoid labyrinth and partially the frontal sinus. All neoplasms were located in the deep parts of the nasal cavity and were poorly visible during anterior rhinoscopy. Based on the extent of the tumor, four were stage I, five were stage II, and five were stage III. Surgical endoscopic treatment of vascular tumors has several unique features. Due to significant intraoperative bleeding, bipolar and monopolar coagulation are mandatory. The need for preoperative embolization in each case is controversial. In our series, only four patients with a confirmed diagnosis and advanced tumors underwent preoperative angiography. In three cases, embolization of the feeding vessel was performed. In one case, no large vessels leading to the tumor were detected. During surgery, to prevent tumor recurrence, it is necessary to remove the soft tissue of the tumor along with the underlying perichondrium and periosteum. If the tumor is located in areas of the maxillary or frontal sinuses that are inaccessible to direct endoscopic observation, it is better to supplement the endonasal approach with an external one; however, such situations did not arise in our series. A patient with hemangioendothelioma underwent subtotal tumor removal, and after diagnosis verification, he underwent a course of radiation therapy with a total dose of 60 Gy. Treatment results were assessed immediately after surgery and then at follow-up periods of 1 to 8 years. During these periods, no continued growth was detected during endoscopic examination of the nasal cavity or operated nasal mucosa. Two patients died of myocardial infarction six years after surgery, at the ages of 75 and 88 years; an examination performed a year earlier revealed no signs of tumor growth in the nasal cavity. No tumor recurrence was detected during examination and repeat biopsy after 1.5 years in the patient with hemangioendothelioma. According to T.V. Kostina (2002), who analyzed the results of surgical treatment of vascular tumors of the nose and nasal mucosa using traditional endonasal and external approaches, tumor recurrence occurred in 8.1% of the operated patients. Of these, exactly half had tumor stages II and III, and the other half had stage IV. In 66.7% of cases, recurrence occurred within a year after surgery, while in the remaining cases, it occurred within one to three years. These data indicate that traditional surgical treatments for vascular tumors are imperfect and that so-called "relapses" are, in fact, continued growth of an incompletely removed primary tumor. Many authors cite even higher failure rates and report that the effectiveness of repeat surgeries for recurrent hemangiomas does not exceed 40% (V.S. Logosov et al., 1988; M.V. Gunchikov, 1997; T.V. Kostina, 2002). Endoscopic technologies of intranasal surgery in combination with the capabilities of modern intraoperative hemostasis and preoperative endovascular embolization allow for the complete and highly effective treatment of vascular tumors of the nasal cavity and the nasal cavity at stages I-III of the disease.