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Krishnan P, Bhosle R, Patel S, Raju D, Cincu R, Moscote-Salazar LR, Gupta A, Agrawal A. Calvarial hemangiomas: Series of 6 cases and review of literature. World Neurosurg X 2024; 23:100297. [PMID: 38511156 PMCID: PMC10950729 DOI: 10.1016/j.wnsx.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Calvarial haemangiomas are benign, vascular tumours of the skull involving parietal and frontal bones. Mostly these lesions remain asymptomatic, and present with cosmetic deformity, headache, uncommon neurological symptoms and reported as case reports and case series. The radiological appearance can range from sessile growing intradiploically to globular and the lesions may extend outwards or inwards after eroding the outer and inner tables of the skull. "Sunburst appearance" and "Wagon-wheel sign" are classical radiological findings but the lesions may present simply as a lytic expansile or even sclerotic calvarial mass. Because of varied clinical presentation and atypical radiological characteristics, the final diagnosis can be clinched by histology only. In selected cases where these lesions are not cosmetically acceptable, en bloc resection with tumour free margins followed by cranioplasty is the treatment of choice. Most reports of calvarial haemangiomas in literature are in the form of case reports.
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Affiliation(s)
- Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Rajesh Bhosle
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Shamshuddin Patel
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Dimble Raju
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Rafael Cincu
- Department of Neurosurgery, General University Hospital, Valencia, Spain
| | | | - Amit Gupta
- Department of Neurosurgery, GSVM Medical College, Kanpur, UP, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020, Madhya Pradesh, India
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Nenashev EA, Vasiliev SA, Vandaeva EV, Levin RS. [Primary intraosseous cavernous hemangioma of the cranium: a case report]. Khirurgiia (Mosk) 2023:113-117. [PMID: 38010025 DOI: 10.17116/hirurgia2023111113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Primary intraosseous cavernous hemangioma (PICH) is a rare benign vascular tumor. This neoplasm is common in the spine and less common in skull. Toynbee J. first described this tumor in 1845. PICH of the cranium does not always have typical X-ray features and should be always differentiated with other more common skull lesions. Surgical resection is preferable since total resection is followed by favorable prognosis. We present a 65-year-old patient with asymptomatic tumor of the right parietal bone. CT revealed osteolytic lesion that required total resection and skull repair. Histopathological analysis revealed intraosseous cavernous hemangioma.
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Affiliation(s)
- E A Nenashev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - S A Vasiliev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - E V Vandaeva
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - R S Levin
- Petrovsky National Research Center of Surgery, Moscow, Russia
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Alexiou GA, Lampros M, Gavra MM, Vlachos N, Ydreos J, Boviatsis EJ. Primary Intraosseous Cavernous Hemangioma of the Cranium: A Systematic Review of the Literature. World Neurosurg 2022; 164:323-329. [PMID: 35654328 DOI: 10.1016/j.wneu.2022.05.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Primary intraosseous cavernous hemangioma (PICH) is a rare, benign tumor of vascular origin, typically arising in the vertebral body. Its presence in the skull is exceedingly rare, with only a few cases being reported worldwide. We carried out the first systematic review of the literature, covering the epidemiology, clinical and imaging features, management, and prognosis of cranial PICH. The literature search revealed 51 studies with 77 patients; the mean age of the patients was 32.7 years with a female predominance of 1.4:1. The majority of cranial PICHs were located in the calvarium, primarily in the frontal and parietal regions, with only a few located in the skull base. The most common initial clinical manifestation was local growth or swelling, followed by a headache. Radiographically, PICHs represented osteolytic, intradiploic masses, which in many cases displayed trabeculations, leading to the so-called "honeycomb" or "starburst" pattern. After contrast administration, PICHs typically enhance. Tumor removal, with craniectomy or en bloc resection and subsequent skull reconstruction, was selected for calvarial PICHs, whereas a transsphenoidal approach, with only partial resection, was applied for clival/sella PICHs. Preoperative embolization, aiming to minimize intraoperative blood loss, was performed in the case of large tumors. At a mean follow-up of 39 months, no patient experienced tumor recurrence, even after subtotal resection. Owing to the benign nature of the tumor, maximal safe resection is recommended as the treatment of choice for patients with cranial PICH.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
| | - Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Maria M Gavra
- Department of CT and MRI Imaging, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - John Ydreos
- Department of Neurosurgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios J Boviatsis
- Department of Neurosurgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Bantan NAA, Abouissa AH, Saeed M, Alwalily MH, Balkhoyour KB, Ashour KM, Hassan AA, Falemban AH, Taher MM. A unique case of multiple calvarial hemangiomas with one large symplastic hemangioma. BMC Neurol 2021; 21:29. [PMID: 33468071 PMCID: PMC7814591 DOI: 10.1186/s12883-021-02053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region. CASE PRESENTATION A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up. CONCLUSIONS Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.
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Affiliation(s)
| | - Ahmed H Abouissa
- Department of Radiology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Muhammad Saeed
- Department of Radiology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | | | | | | | - Amal Ali Hassan
- Department of Laboratory Medicine, Division of Histopathology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.,Faculty of Medicine, Department of Pathology, Al Azhar University, Cairo, Egypt
| | - Afnan Hisham Falemban
- Department of Laboratory Medicine, Division of Histopathology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Mohiuddin M Taher
- Department of Medical Genetics, Umm-Al-Qura University, Makkah, Saudi Arabia. .,Science and Technology Unit, Umm-Al-Qura University, Makkah, Saudi Arabia.
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Campbell JI, Mural M, Rubino F, Lopez ES, Cervio A, Olvi L. Clivus Hemangioma in a Pediatric Patient: Case Report. World Neurosurg 2019; 130:512-515. [PMID: 31279922 DOI: 10.1016/j.wneu.2019.06.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hemangiomas are benign blood vessels tumors that represent less than 1% of all the bone neoplasms. Calvarial hemangiomas are mainly solitary lesions commonly located in the frontal and parietal bone; however, they may occur in any skull region. These tumors increase in size over a period of months to years before they start showing their first symptoms such as headache, bone deformity, and pathological fractures. Differential diagnosis with osteosarcoma should be considered. Surgical resection with a safety margin is a standard treatment of the cranial hemangioma. Furthermore, radiotherapy has proven to stop the tumor's growth but not its size. CASE DESCRIPTION We treated an 11-year-old male who had a rare case of a capillary hemangioma located in the clivus bone. The patient underwent 2 endoscopic endonasal resection because of tumor recurrence. Surgical safety margins are highly recommended, but this procedure could not be performed because of the tumor's location. After the second relapse, the oncology team decided to initiate radiotherapy. At 6-month follow-up, the tumor reduced its size and remained unchanged. CONCLUSIONS Surgical safety margins are highly important to prevent recurrence in this type of bone tumors. Skull base hemangiomas are a big challenge when you want to achieve these safety margins. We believe that a combined treatment of surgery and radiotherapy should be considered as the main treatment.
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Affiliation(s)
- Juan Iaconis Campbell
- Department of Neurosurgery, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina.
| | - Miguel Mural
- Department of Neurosurgery, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Franco Rubino
- Department of Neurosurgery, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Eduardo Salas Lopez
- Department of Neurosurgery, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Andres Cervio
- Department of Neurosurgery, FLENI, Buenos Aires, Argentina
| | - Liliana Olvi
- Orthopedic Pathology Institute, Buenos Aires, Argentina
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Abstract
OBJECTIVES The authors describe a case of congenital calvarial hemangioma successfully managed using propranolol therapy. Presenting symptoms, radiological and pathological features, differential diagnosis, and management of this rare congenital mass are described. CASE PRESENTATION A 2-year-old boy presented with a 1-year history of a growing right parietal skull mass. No obvious etiology was apparent. No focal neurological deficits or associated craniofacial anomalies were identified. Plain film imaging demonstrated focal thickening of the right parietal bone with internal trabeculations in a sunburst appearance. Computed tomography (CT) scan showed bone thickening with coarsening of the bony trabeculae, minor irregularity of the outer table, unaffected inner table, and no evidence of aggressive features. A diagnostic biopsy of the lesion was performed in the operating room. Microscopic examination was consistent with hemangioma. Based on histological and radiological features of the lesion, it was identified as a cavernous hemangioma. Medical treatment utilizing propranolol was initiated for over 3 years with interval reduction in the lesion size. MRI head following treatment with propranolol demonstrated reduction of the mass compared to preoperative imaging. CONCLUSIONS Although a rare entity, it is important to consider congenital calvarial hemangioma in the differential diagnosis of slow growing skull lesions due to the possibility of complications as a result of the hemangioma's intracranial extension, and the potential for treatment. En bloc resection has classically been described as a treatment for such lesions, although our case demonstrates that medical treatment with propranolol therapy may be appropriate in certain situations.
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Kirmani AR, Sarmast AH, Bhat AR. A unique case of calvarial hemangioma. Surg Neurol Int 2016; 7:S398-401. [PMID: 27313966 PMCID: PMC4901824 DOI: 10.4103/2152-7806.183498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Calvarial hemangiomas are one of the rarest neoplasms affecting the skull, predominantly occurring in parietal and frontal bones. Case Description: We report a parietal hemangioma in a middle-aged female which presented as a painless swelling that was progressively increasing in size and was treated surgically. Conclusion: Although rare, calvarial hemangioma should be a part of the differential diagnosis of calvarial swellings.
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Affiliation(s)
- Altaf Rehman Kirmani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arif Hussain Sarmast
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Abdul Rashid Bhat
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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8
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Zhong W, Li G, Huang S, Chen H, You C. Intradiploic hemangioma with repeated hemorrhage in a child with hemophilia. J Neurosurg Pediatr 2012; 10:56-9. [PMID: 22702325 DOI: 10.3171/2012.3.peds11423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intraosseous hemangioma is an uncommon benign vascular tumor, which is most frequently found in middle-aged female patients. The clinical course is usually insidious and the outcome excellent after total resection. The authors report a case of a calvarial hemangioma in a child with hemophilia who experienced a catastrophic postoperative hematoma and discuss the mechanism, clinical features, and treatment of this condition.
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Affiliation(s)
- Weiying Zhong
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Eap C, Litre CF, Jazeron JF, Theret E, Duntze J, Patey M, Rousseaux P. [Intradiploic cavernous hemangioma of the calvaria: case report and review of the literature]. Neurochirurgie 2010; 57:42-5. [PMID: 20870256 DOI: 10.1016/j.neuchi.2010.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 07/09/2010] [Indexed: 11/15/2022]
Abstract
We report the case of a 31-year-old patient who had had frontal cephalalgias for several years. CT and MRI anatomical imaging objectified a frontal osteolytic tumor respecting the osseous external table but compressing the superior sagittal sinus. Total en bloc resection of the tumor associated with titan cranioplasty was performed. The postoperative course was uneventful. Three months after surgery the patient no longer reported headache. The anatomical and pathological results concluded in intradiploic cavernous hemangioma. We discuss this case and others described in the literature.
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Affiliation(s)
- C Eap
- Service de neurochirurgie, hôpital Maison-Blanche, CHU de Reims, 45 rue Cognacq-Jay, Reims, France.
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10
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Vega A, De Obieta E, Aguado G, Esqueda M, Ruíz S, Ramirez E, Pérez J. Hemangioma cavernoso multifocal en cráneo. Revisión de un caso. Neurocirugia (Astur) 2010. [DOI: 10.1016/s1130-1473(10)70101-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kang DW, Choi CH. A case of calvarial hemangioma in cranioplasty site. J Korean Neurosurg Soc 2009; 46:484-7. [PMID: 20041060 DOI: 10.3340/jkns.2009.46.5.484] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 02/19/2009] [Accepted: 10/22/2009] [Indexed: 11/27/2022] Open
Abstract
It is not uncommon for hemangiomas to occur in the calvarium, accounting for about 10% of the benign skull tumors. A 46-year-old man was presented with a palpable scalp mass on the left parietal region. Past medical history indicated that he had undergone cranioplasty 25 years prior due to a depressed skull fracture suffered from a traffic accident. Magnetic resonance imaging revealed mixed signal intensity mass on T1 -and T2-weighted images pushing a linear signal void lesion outward in the left parietal region. After total surgical removal along with cranioplasty, he was discharged without neurological deficits. Histological examination of the surgical specimen revealed a cavernous hemangioma. A skull hemangioma occurring at the site of a cranioplasty has not yet been reported. Therefore, authors report this case in combination with a pertinent literature review.
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Affiliation(s)
- Dong Wan Kang
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Satoh K, Ohtsuka T, Abe T, Yokota K, Kunii K. Haemangioma of the forehead: Radiographic diagnosis and definitive surgical treatment in a Japanese series. ACTA ACUST UNITED AC 2009; 43:75-81. [DOI: 10.1080/02844310802602358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Cosar M, Eser O, Aslan A, Korkmaz S, Boyaci G, Aktepe F. Intradiploic cavernous hemangioma of the skull in a child: a case report. Childs Nerv Syst 2008; 24:975-7. [PMID: 18431554 DOI: 10.1007/s00381-008-0638-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intradiploic cavernous hemangioma of the skull is seen rarely. Intradiploic cavernous hemangiomas arise from the intrinsic vasculature of the bone and generally picks up at the fourth and fifth decades. DISCUSSION AND CONCLUSION In this report, we present a 16-year-old child who was admitted with a swelling lesion in the right parietal bone and diagnosed as cavernous hemangioma after total extirpation.
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Affiliation(s)
- Murat Cosar
- Faculty of Medicine, Department of Neurosurgery, Canakkale 18 March University, Canakkale, Turkey.
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14
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Buhl R, Barth H, Dörner L, Nabavi A, Rohr A, Mehdorn HM. De novo development of intraosseous cavernous hemangioma. J Clin Neurosci 2007; 14:289-92. [PMID: 17258139 DOI: 10.1016/j.jocn.2005.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 11/28/2005] [Accepted: 12/01/2005] [Indexed: 10/23/2022]
Abstract
Intraosseous cavernous hemangiomas are rare and not often multifocal. De novo development of a skull cavernous hemangioma has not been described previously. We present a 20-year-old man who was operated upon for a skull cavernoma in the right frontal area and developed a new lesion 3 years later in the right occipital region. The first lesion was removed completely and the postoperative course was uneventful. Histology showed an intraosseous cavernous hemangioma. MRI follow-up revealed a new lesion in the right occipital region. At the time of the first operation this lesion was not seen on CT or MRI scan. Surgical removal was performed and histology again showed a cavernous hemangioma. The patient seems to be unique and it is important to keep young patients with the diagnosis of cavernous hemangioma under close follow-up. This supports the experience from parenchymatous cavernous hemangiomas that this malformation may become a dynamic disease.
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Affiliation(s)
- Ralf Buhl
- Department of Neurosurgery, University of Schleswig Holstein, Schittenhelmstr. 10, 24105 Campus Kiel, Germany.
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15
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Clauser L, Mandrioli S, Polito J, Galiè M. Surgical techniques for the removal of forehead hemangioma. J Craniofac Surg 2006; 17:702-4. [PMID: 16877918 DOI: 10.1097/00001665-200607000-00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Hemangiomas of the bone are rare tumors, accounting for 0.5-1% of all benign skeletal tumors. Most of these tumors are found in the vertebral bodies and they are rarely seen in the cranial bones, where their frequency is 0.2% of all bone neoplasms. The authors, after reviewing the literature, describe their experience with a case of frontal bone hemangioma.
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Affiliation(s)
- Luigi Clauser
- Department of Cranio Maxillo Facial Surgery, Center of Orbital Pathology and Surgery, St. Anna Hospital and University, Ferrara, Italy.
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16
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Dogan S, Kocaeli H, Sahin S, Korfali E, Saraydaroglu O. Large cavernous hemangioma of the frontal bone. Neurol Med Chir (Tokyo) 2005; 45:264-7. [PMID: 15914968 DOI: 10.2176/nmc.45.264] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 53-year-old woman presented with a rare case of cavernous hemangioma of the frontal bone manifesting as right frontal stabbing headache and local swelling. Computed tomography revealed an extensive, well-defined, radiolucent, osteolytic lesion in the right frontal bone. The inner and outer tables of the skull were eroded and the lesion had compressed the brain parenchyma. Right frontal craniotomy was performed, and the lesion with a 1 cm-wide margin of surrounding uninvolved bone was removed. The defect was reconstructed with titanium mesh. The patient did well after the operation. The cosmetic results were satisfactory and follow up at 6 months post-surgery revealed no recurrence.
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Affiliation(s)
- Seref Dogan
- Department of Neurosurgery, Uludag University School of Medicine, Bursa, Turkey.
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17
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Khanam H, Lipper MH, Wolff CL, Lopes MB. Calvarial hemangiomas: report of two cases and review of the literature. SURGICAL NEUROLOGY 2001; 55:63-7; discussion 67. [PMID: 11248320 DOI: 10.1016/s0090-3019(00)00268-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Primary hemangiomas of the bone are uncommon tumors, accounting for less than 1.0% of all bone neoplasms. These tumors are mostly found in vertebral bodies. Hemangiomas are rarely seen in the calvarium, where their frequency is 0.2% of all bone neoplasms. Because of their infrequent appearance in the skull, vague symptoms, and absence of prototypical radiological findings, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. CASE DESCRIPTION We report two cases of calvarial hemangiomas: one with a single mass on the right sphenoid wing, and another with two similar lesions on the right occipital and left parietal bones. The diagnoses could be established only by histopathologic analysis. CONCLUSION Histopathologic confirmation of the tumor is the definitive method for diagnosis of intraosseous hemangiomas. Radiological findings are not always characteristic for calvarial hemangiomas. Due to possible complications and the possibility of effective treatment, this lesion should always be considered in the differential diagnosis of skull lesions.
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Affiliation(s)
- H Khanam
- University of Virginia Health Sciences Center, Department of Pathology, Box 800-214, Charlottesville, VA 22908-0214, USA
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18
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Schroeder HW, Schweim C, Schweim KH, Gaab MR. Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging. J Neurosurg 2000; 93:237-44. [PMID: 10930009 DOI: 10.3171/jns.2000.93.2.0237] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow. METHODS In 14 healthy volunteers and in eight patients with aqueductal stenosis who had undergone endoscopic aqueductoplasty, aqueductal CSF flow was investigated using cine cardiac-gated phase-contrast MR imaging. For qualitative evaluation of CSF flow, the authors used an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct. Evaluation revealed no significant difference in aqueductal CSF flow between healthy volunteers and patients with regard to temporal parameters, CSF peak and mean velocities, mean flow, and stroke volume. All restored aqueducts have remained patent 7 to 31 months after surgery. CONCLUSIONS Aqueductal CSF flow after endoscopic aqueductoplasty is similar to aqueductal CSF flow in healthy volunteers. The data indicate that endoscopic aqueductoplasty seems to restore physiological aqueductal CSF flow.
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Affiliation(s)
- H W Schroeder
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany.
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19
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Schroeder HWS, Schweim C, Schweim KH, Gaab MR. Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging. Neurosurg Focus 2000. [DOI: 10.3171/foc.2000.9.2.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow.
Methods
In 14 healthy volunteers and in eight patients with aqueductal stenosis who had undergone endoscopic aqueductoplasty, aqueductal CSF flow was investigated using cine cardiac-gated phase-contrast MR imaging. For qualitative evaluation of CSF flow, the authors used an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct. Evaluation revealed no significant difference in aqueductal CSF flow between healthy volunteers and patients with regard to temporal parameters, CSF peak and mean velocities, mean flow, and stroke volume. All restored aqueducts have remained patent 7 to 31 months after surgery.
Conclusions
Aqueductal CSF flow after endoscopic aqueductoplasty is similar to aqueductal CSF flow in healthy volunteers. The data indicate that endoscopic aqueductoplasty seems to restore physiological aqueductal CSF flow.
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