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Fath L, Simon F, Levy R, Boccara O, Couloigner V. Dangers and therapeutic difficulties of intracranial hemangioma in infants: A CARE case report. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:227-230. [PMID: 38395664 DOI: 10.1016/j.anorl.2024.02.001] [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: 02/25/2024]
Abstract
INTRODUCTION Description of neurological complications induced by intracranial hemangioma in infants and by the initiation of beta-blocker treatment (propranolol). OBSERVATION A 2-month-old infant was referred for grade 5 non-congenital unilateral peripheral facial palsy. Work-up revealed ipsilateral profound hearing loss and two intracranial hemangiomas: one in the ipsilateral internal auditory canal (IAC), the other in the cerebellum opposite the nodule of vermis. Initial treatment with a beta-blocker (propranolol 1mg/kg/day for 1month, then 3mg/kg/day) resulted in disappearance of symptoms and regression of lesions within 8weeks. At 20months after introduction of maintenance therapy (propranolol 3mg/kg/day), two asthma attacks occurred, leading to initiation of fluticasone and continuation of the beta-blocker. Thirty months after discontinuation of treatment, no further progression was noted. DISCUSSION Unilateral facial palsy in an infant suggests a number of diagnoses. MRI revealed IAC hemangioma. The choice of dosage and duration of treatment was based on a review of the literature and a strategy defined in multidisciplinary consultation.
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Affiliation(s)
- Léa Fath
- Service d'ORL et Chirurgie Cervicofaciale Pédiatrique, Hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
| | - François Simon
- Service d'ORL et Chirurgie Cervicofaciale Pédiatrique, Hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Raphaël Levy
- Service de Radiologie Pédiatrique, Hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Olivia Boccara
- Service de Dermatologie Pédiatrique, Hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Vincent Couloigner
- Service d'ORL et Chirurgie Cervicofaciale Pédiatrique, Hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Ribeiro L, Dunoyer C, Trinquet A, Cagnazzo F, Boetto J, Le Corre M. Adult transverse sinus capillary hemangioma: case report and review of the literature. Neurochirurgie 2024; 70:101573. [PMID: 38851138 DOI: 10.1016/j.neuchi.2024.101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Adult intracranial capillary hemangioma (ICH) is an extremely rare disease with very few cases reported in the literature. Natural history is poorly understood and therapeutic management has not been clearly defined. METHODS Using PRISMA guidelines, we systematically reviewed all published adult cases of ICH, to which we added our own case. CASE PRESENTATION A 24-year-old patient with intracranial hypertension underwent stenting for left transverse sinus ICH. Recurrence was managed by subtotal resection, and radiotherapy was undertaken after a second relapse. Radiotherapy achieved complete response at last follow-up. RESULTS Among cases of ICH found in the literature, 36 concerned adults (55.3%), with clear female predominance, and only 2 cases affecting the transverse sinus (8.1%). Adult ICHs grew over time, and pregnancy seemed to accelerate natural progression. Complete resection was achieved in most cases, and radiotherapy was used in case of relapse, with high rates of tumor control. CONCLUSION Transverse sinus ICH is uncommon, and venous stenting is a suitable option in case of tumor invasion to treat intracranial hypertension. Surgery is the gold-standard treatment, and radiotherapy is a very effective alternative, with high rates of tumor control. Natural history is not benign, particularly in case of pregnancy.
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Affiliation(s)
- Lucas Ribeiro
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
| | - Clément Dunoyer
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Aude Trinquet
- Department of Neuropathology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Julien Boetto
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Institute of Functional Genomics (IGF), Université de Montpellier, CNRS, INSERM, U1191, Montpellier, France
| | - Marine Le Corre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Alexandre AM, Romi A, Gaudino S, Gessi M, Frassanito P, Camilli A, Luca S, Pedicelli A. Giant Congenital Hemangioma of the Skull: Prenatal Diagnosis and Multimodal Endovascular and Surgical Management. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:145. [PMID: 38256405 PMCID: PMC10821461 DOI: 10.3390/medicina60010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Introduction: calvarial capillary hemangiomas are vascular tumors rarely seen in newborns. Differential diagnosis may be not straightforward on imaging studies and the management depends on patient and lesion characteristics. Case report: we present the case of a large congenital intracranial extra-axial lesion detected by routine prenatal US screening, a giant calvarial congenital hemangioma, treated with a multimodal strategy. Neonatal MR showed a hemorrhagic solid lesion, causing compression of brain tissue. Conservative treatment was attempted, but a one-month follow-up MR showed growth of the lesion with increased mass effect. Pre-operative endovascular embolization and surgical resection were performed. The pathology was consistent with intraosseous capillary hemangioma. The post-operative course was uneventful. At the 8-month follow-up, the patient had no clinical deficits and MR showed complete resection of the lesion. At the 13-month follow-up, the patient was asymptomatic, showing normal neurological examination and psychophysical development. Conclusions: although wait-and-see policy is feasible for small and asymptomatic lesions, radical resection is indicated when the mass is large, thus causing severe mass effect on the brain. Hypervascularization of the tumor may be responsible for hemorrhagic complications and severe anemia. On these grounds, endovascular treatment is feasible and effective to reduce hemorrhagic complications.
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Affiliation(s)
- Andrea M. Alexandre
- UOSA Interventional Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.M.A.); (A.P.)
| | - Andrea Romi
- Neuroradiology Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Simona Gaudino
- Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Paolo Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | | | - Scarcia Luca
- Department of Neuroradiology, Henri Mondor Hospital, 94000 Creteil, France
| | - Alessandro Pedicelli
- UOSA Interventional Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.M.A.); (A.P.)
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Albalawi SF, Hafiz BE, Turki A, Alturkustani M, Bakhsh SI, Sabbagh AJ. Intracranial Infantile Hemangioma: Highlighting a Rare Presentation With a Case Report and Literature Review. Cureus 2024; 16:e52341. [PMID: 38361697 PMCID: PMC10867379 DOI: 10.7759/cureus.52341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Infantile hemangioma is a common benign vascular tumor in children, but it is very unusual to be found intracranially. Our literature review identified 44 reported cases. Presentation can vary from asymptomatic to a life-threatening presentation that necessitates urgent surgical removal. There is no general consensus on management of these rare lesions and until recently, treatment was limited to surgery or pharmacological management with steroids, propranolol or interferon. We present a case of a four-week-old male infant with history of vomiting and increase in head circumference since birth. MRI of the brain revealed a large complex cyst occupying the right frontoparietal region, with round soft tissue component that is isointense on T1 and hyperintense on T2 weighted images. Complete surgical resection with evacuation of the cyst was achieved. Histopathology of the mass showed infantile hemangioma with positive CD31 on immunohistochemistry. The patient achieved an excellent outcome following surgical resection.
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Affiliation(s)
- Sultan F Albalawi
- Neurological Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Badr E Hafiz
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Alanoud Turki
- Neurology, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Salwa I Bakhsh
- Pathology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Abdulrahman J Sabbagh
- Training Administration, Saudi Commission for Health Specialties, Makkah, Jeddah and Taif, SAU
- Surgery, King Abdulaziz University Hospital, Jeddah, SAU
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Safe and Effective Treatment of Intracranial Infantile Hemangiomas with Beta-Blockers. Pediatr Rep 2021; 13:347-356. [PMID: 34287374 PMCID: PMC8293324 DOI: 10.3390/pediatric13030043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/07/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022] Open
Abstract
Infantile hemangiomas are common benign vascular tumors but are rarely found in an intracranial location. Our literature review identified 41 reported cases. There is no general consensus on management of these rare lesions and until recently, treatment was limited to surgery or pharmacological management with steroids or interferon. Although beta-blockers have been widely prescribed in the treatment of cutaneous infantile hemangiomas since 2008, their use in the treatment of intracranial infantile hemangiomas has been minimal. We present a case of infantile hemangioma affecting the right orbit, associated with intracranial extension, causing intermittent right facial nerve palsy. The patient achieved an excellent outcome following combined treatment with oral propranolol and topical timolol maleate 0.5%, with complete regression of the lesion by 4 months. We conclude that beta-blockers are a safe and effective treatment of intracranial infantile hemangiomas and can be employed as first-line management of these lesions.
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Santoro G, Piccirilli M, Chiarella V, Greco N, Berra LV, Santoro A. Intracranial capillary hemangiomas: literature review in pediatric and adult population. Neurosurg Rev 2020; 44:1977-1985. [PMID: 33079288 DOI: 10.1007/s10143-020-01419-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Capillary hemangiomas (CHs) of the central nervous system represent a rare diagnosed pathology. CHs are benign vascular tumors whose most common manifestations are dermal and mucous and mainly occur during childhood or adolescence, while the involvement of the central nervous system can occur in a wider age range. We conducted a PubMed research on literature published until March 2020. We only enrolled cases with histological documented presence of intracranial CH. For every case collected, we analyzed age, sex, localization, neuroimaging studies performed, the presence of extracranial CHs, symptoms, neurological deficits, extent of surgical resection (biopsy, partial or gross total), adjunct treatment received (radiotherapy, chemotherapy, Trans-Arterial Embolization TAE), and outcome. Up to March 2020, the literature review identified 52 cases to which we added the case of our personal experience. The mean age was 26 with slightly female prevalence (28 F, 25 M). The most common presenting symptom was headache (21 cases, 40%). The surgical treatment consisted of biopsy in 7 cases (13%), partial resection in 10 cases (19%), gross total resection in 31 cases (58.5%), biopsy followed by total resection in 2 cases (3%), and partial resection followed by total resection in 1 case (1.5%), and the diagnosis was obtained from an autopsy sample in 1 case (1.5%). For symptomatic lesions, surgery is a valid option to obtain histological characterization, neurological improvement, and where possible a total resection. Stereotactic radiotherapy can be used if the lesion is not surgically approachable or as an adjuvant treatment in case of partial resection, having shown good results in terms of long-term disease control.
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Affiliation(s)
- Giorgio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Manolo Piccirilli
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Vito Chiarella
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy.
| | - Nicoletta Greco
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Aldo Moro University, Bari, Italy
| | | | - Antonio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
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