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Lammy S, Brown J, Littlechild P. Cavernous sinus haemangioma masquerading as a pituitary macroadenoma: how the unexpected lurks in neurosurgery. Br J Neurosurg 2023; 37:234-236. [PMID: 33332201 DOI: 10.1080/02688697.2020.1861437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cavernous sinus haemangiomas are neoplastic lesions notoriously difficult to diagnose and excise. We present a case of a lesion that was clinically, biochemically, and radiologically consistent to a giant pituitary macroadenoma and discuss the unexpected near intra-operative exsanguination which enabled a pathognomonic diagnosis of a much rarer lesion to be made. This highlights the sinister nature of such a lesion, and its potential impact on patient care if partially excised, and that despite our advances in neurosurgical diagnostics the unexpected is to be expected.
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Affiliation(s)
- Simon Lammy
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Jennifer Brown
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
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A radiomics-based study for differentiating parasellar cavernous hemangiomas from meningiomas. Sci Rep 2022; 12:15509. [PMID: 36109577 PMCID: PMC9478116 DOI: 10.1038/s41598-022-19770-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractTo investigate the value of the radiomic models for differentiating parasellar cavernous hemangiomas from meningiomas and to compare the classification performance with different MR sequences and classifiers. A total of 96 patients with parasellar tumors (40 cavernous hemangiomas and 56 meningiomas) were enrolled in this retrospective multiple-center study. Univariate and multivariate analyses were performed to identify the clinical factors and semantic features of MRI scans. Radiomics features were extracted from five MRI sequences using radiomics software. Three feature selection methods and six classifiers were evaluated in the training cohort to construct favorable radiomic machine-learning classifiers. The performance of different classifiers was evaluated using the AUC and compared to neuroradiologists. The detection rates of T1WI, T2WI, and CE-T1WI for parasellar cavernous hemangiomas and meningiomas were approximately 100%. In contrast, the ADC maps had the detection rate of 18/22 and 19/25, respectively, (AUC, 0.881) with 2.25 cm as the critical value diameter. Radiomics models with the SVM and KNN classifiers based on T2WI and ADC maps had favorable predictive performances (AUC > 0.90 and F-score value > 0.80). These models outperformed MRI model (AUC 0.805) and neuroradiologists (AUC, 0.756 and 0.545, respectively). Radiomic models based on T2WI and ADC and combined with SVM and KNN classifiers have the potential to be a viable method for differentiating parasellar hemangiomas from meningiomas. T2WI is more universally applicable than ADC values due to its higher detection rate for parasellar tumors.
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Multiple Extraaxial Cavernous Hemangiomas: Rare Entity. World Neurosurg 2019; 130:364-368. [DOI: 10.1016/j.wneu.2019.07.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022]
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Pechenkina K, Fan W, Luo X. What's that big thing on your head? Diagnosis of a large frontoparietal lesion on an Eastern Zhou skull from Henan, China. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 26:84-92. [PMID: 31349131 DOI: 10.1016/j.ijpp.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
We carried out a differential diagnosis of a large frontoparietal lesion on a human skull from a Late Bronze Age archaeological site located on the Central Plain of China, dating to between 771 and 476 BC. The head of this individual was covered in cinnabar, a mercury-based pigment that later was used for medicinal purposes in China. The lesion was well-circumscribed and involved the outer and inner tables of the skull, slight diploë thickening, and coarsening of bone trabeculae with expansion of intertrabecular spaces. We show that the observed changes are most consistent with cavernous hemangioma of the skull, a benign vascular malformation that preferentially affects older adults. Hemangiomas are often neglected in the paleopathological literature because of their benign nature - they tend to be asymptomatic and do not affect quality of life to a significant degree. Nevertheless, they produce characteristic lesions that can be confused with several other conditions with unrelated etiologies, including congenital hemoglabinopathies, traumas, malignant or benign neoplasms, and Paget's disease. We outline the diagnostic criteria that distinguish cavernous hemangioma from other conditions affecting the skull.
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Affiliation(s)
| | - Wenquan Fan
- Henan Provincial Institute of Cultural Relics and Archaeology, China
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Chen H, Wang X, Yao S, Raza HK, Jing J, Cui G, Hua F. The aetiologies of unilateral oculomotor nerve palsy: a clinical analysis on 121 patients. Somatosens Mot Res 2019; 36:102-108. [PMID: 31035834 DOI: 10.1080/08990220.2019.1609438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hao Chen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaohua Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shan Yao
- Xuzhou Central Hospital, Xuzhou, China
| | - Hafiz Khuram Raza
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- School of International Education, Xuzhou Medical University, Xuzhou, China
| | - Jia Jing
- School of International Education, Xuzhou Medical University, Xuzhou, China
- Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Fang Hua
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Key laboratory of Anesthesilogy of Jiangsu Province, Xuzhou, China
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Raza HK, Chen H, Chansysouphanthong T, Cui G. The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature. Somatosens Mot Res 2018; 35:229-239. [PMID: 30592440 DOI: 10.1080/08990220.2018.1547697] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oculomotor nerve palsy (ONP) is an important and common clinical diagnosis. Its main features are diplopia and ptosis. Its aetiologies are various and complex. A number of different conditions have been reported to cause ONP, such as diabetes mellitus, aneurysm, tumours, painful ophthalmoplegia, pituitary lesions, cavernous sinus lesions, central nervous system infections, and subarachnoid haemorrhage. A patients needs to undergo several tests in order to establish the correct underlying pathology. In this review, we have summarized the aetiologies of the unilateral ONP, and discussed their relative clinical features, pathogenesis, diagnostic criteria, treatment options, and prognosis. We searched PubMed for papers related to ONP and its aetiologies, and selected the publications, which seemed appropriate.
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Affiliation(s)
- Hafiz Khuram Raza
- a School of International Education , Xuzhou Medical University , Xuzhou , China
| | - Hao Chen
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | | | - Guiyun Cui
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
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Lan Z, Richard SA, Li J, Xu J, You C. A giant solid cavernous hemangioma mimicking sphenoid wing meningioma in an adolescent: A case report. Medicine (Baltimore) 2018; 97:e13098. [PMID: 30383694 PMCID: PMC6221700 DOI: 10.1097/md.0000000000013098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Central nervous system (CNS) solid cavernous hemangiomas are rare extra-axial anomalies that may sometimes resemble meningiomas. Due to their complex vascular nature, accurate preoperative diagnosis is important to avoid disastrous hemorrhage during operation. To the best of our knowledge this is the first case in an adolescent since all middle cranial fossa hemangioma cases reported in literature are adults in their 40s or 50s and all the pediatric cases are cystic. PATIENT CONCERNS We present a case of a 14-year-old girl with headache and dizziness for 3 months. She occasionally experienced nausea and vomiting but denied visual disturbances and loss of smell. DIAGNOSES MRI revealed a lesion that extends to the greater wing of the sphenoid bone as well as the pituitary fossa. Our initial diagnosis was a sphenoid wing meningioma but interestingly, histopathology revealed solid cavernous hemangioma. INTERVENTIONS The residual tumor was completely removed with 2 sessions of Gamma Knife radiotherapy after surgery. OUTCOMES We were confronted with excessive bleeding during surgery so we attained subtotal resection. However, the patient recovered well with no recurrence of the tumor. LESSONS Our case shows that space occupying lesions involving the cavernous sinus and sphenoid ridged could be easily misdiagnosed as sphenoid wing meningiomas in children and adolescents and even adults therefore great care must be exercised when confronted with this kind of presentation.
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Affiliation(s)
- Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
- Department of Surgery, Volta Regional Hospital, Ghana, West Africa
| | - Jin Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
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Narvid J, Talbott JF, Glastonbury CM. The caverno-apical triangle: anatomic-pathological considerations and pictorial review. Clin Imaging 2015; 40:23-32. [PMID: 26481233 DOI: 10.1016/j.clinimag.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The caverno-apical triangle (CAT) is defined from the components that define its contours: the cavernous sinus and the orbital apex. A wide range of pathologies arise from the space between the cavernous sinus and the orbital apex. OBJECT To better define radiologically this critical anatomic landmark and establish an organized approach for image analysis to help generate focused differential diagnoses and accurately characterize lesions found on imaging. CONCLUSION We have identified common imaging characteristics of frequently encountered lesions and divided them into specific categories to facilitate creation of logical and focused differential diagnoses.
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Affiliation(s)
- Jared Narvid
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Jason F Talbott
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Christine M Glastonbury
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Cavernous hemangioma of the skull and meningioma: association or coincidence? Case Rep Neurol Med 2015; 2015:716837. [PMID: 25960899 PMCID: PMC4415757 DOI: 10.1155/2015/716837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/26/2015] [Accepted: 04/04/2015] [Indexed: 11/18/2022] Open
Abstract
Intraosseous cavernous hemangiomas of the skull are rare. Meningiomas are quite frequently encountered in a neurosurgical practice. The association between these two entities is nevertheless very uncommon. The authors present a case of a 72-year-old woman suffering from headache. The MRI showed a parietal meningioma with adjacent thick bone. The meningioma and the bone were removed. The histological examination confirmed the diagnosis of meningioma and revealed a cavernoma of the skull. The relationship between the lesions suggests more than a coincidental association. Several hypotheses are proposed to explain common causal connections.
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Cavernous Sinus: A Comprehensive Review of its Anatomy, Pathologic Conditions, and Imaging Features. Clin Neuroradiol 2014; 25:109-25. [PMID: 25410584 DOI: 10.1007/s00062-014-0360-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
Abstract
The purpose of this article was to review the anatomy of the cavernous sinus (CS), illustrate numerous lesions that can affect the CS, and emphasize the imaging characteristics for each lesion to further refine the differential diagnoses. The CS, notwithstanding its small size, contains a complicated and crucial network that consists of the carotid artery, the venous plexus, and cranial nerves. The wide-ranging types of pathologies that can involve the CS can be roughly classified as tumoral, congenital, infectious/inflammatory/granulomatous, and vascular. Conditions that affect the CS usually lead to symptoms that are similar to each other; thus, for diagnosis, imaging procedures are required. Radiological evaluations are also required to detect pre- and postoperative CS invasion. Magnetic resonance imaging, which can be supplemented with thin-section contrast-enhanced sequences, is the preferred imaging technique for evaluating the CS. For correct diagnosis of CS lesions and accurate evaluations of CS invasions, it is essential to carefully analyze the anatomical structures within the CS and to acquire precise knowledge about the imaging features of CS lesions, which may frequently overlap.
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Xiao HF, Lou X, Liu MY, Wang YL, Wang Y, Chen ZY, Shi KN, Ma L. The role of magnetic resonance diffusion-weighted imaging and three-dimensional arterial spin labelling perfusion imaging in the differentiation of parasellar meningioma and cavernous haemangioma. J Int Med Res 2014; 42:915-25. [PMID: 24903554 DOI: 10.1177/0300060514531918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/24/2014] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the diagnostic value of magnetic resonance diffusion-weighted imaging (DWI) and three-dimensional arterial spin labelling perfusion imaging (3D-ASL) in distinguishing cavernous haemangioma from parasellar meningioma, using histological data as a reference standard. Methods Patients with parasellar meningioma or parasellar cavernous haemangioma underwent conventional T1- and T2-weighted magnetic resonance imaging (MRI) followed by DWI and 3D-ASL using a 3.0 Tesla MRI. The minimum apparent diffusion coefficient (minADC) from DWI and the maximal normalized cerebral blood flow (nCBF) from 3D-ASL were measured in each tumour. Diagnosis was confirmed by histology. Results MinADC was significantly lower and nCBF significantly higher in meningioma ( n = 19) than cavernous haemangioma ( n = 15). There was a significant negative correlation between minADC and nCBF ( r = −0.605). Conclusion DWI and 3D-ASL are useful in differentiating cavernous haemangiomas from parasellar meningiomas, particularly in situations when the appearance on conventional MRI sequences is otherwise ambiguous.
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Affiliation(s)
- Hua-Feng Xiao
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Meng-Yu Liu
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Yu-Lin Wang
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Zhi-Ye Chen
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Kai-Ning Shi
- General Electric Company GE (China) Co., Ltd, Healthcare, Beijing, China
| | - Lin Ma
- Department of Radiology, PLA General Hospital, Beijing, China
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He K, Chen L, Zhu W, Mao Y. Magnetic Resonance Standard for Cavernous Sinus Hemangiomas: Proposal for a Diagnostic Test. Eur Neurol 2014; 72:116-24. [DOI: 10.1159/000358872] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 01/19/2014] [Indexed: 11/19/2022]
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