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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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Zhu J, Cong Z, Ma C. Endoscopic endonasal transsphenoidal surgery for the cavernous sinus hemangioma: Surgical application and review of the literature. World Neurosurg X 2023; 18:100179. [PMID: 37008562 PMCID: PMC10064423 DOI: 10.1016/j.wnsx.2023.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Aim Cavernous sinus hemangiomas (CSHs) are hypervascular malformations and the surgical treatment is technically demanding. Although some articles have reported resection of CSHs using endoscopic endonasal transsphenoidal surgery (EETS), most of them were encountered for a lack of preoperative strategy guidance. Herein, we reported gross total resection (GTR) of intrasellar CSHs in two patients undergoing strategical EETS and compared EETS with frontotemporal craniotomy (FC) and stereotactic radiosurgery by literature review. Material and methods Two patients with CSHs who underwent EETS were reported. The literature review was conducted to exhaust studies that reported surgical treatment for CSHs. The tumor resection rate, and the postoperative short-term and long-term newly-developed or deteriorative cranial-nerve function rates were extracted. Results GTR was achieved with no postoperative complications in the two cases. Nine articles reported 14 cases undergoing EETS for CSHs and twenty-three articles reported 195 cases undergoing FC for CSHs. The GTR rates of EETS and FC were 57.14% (8/14) and 78.97% (154/195) respectively. The postoperative short-term and long-term newly-developed or deteriorative cranial-nerve function rates were 0% (0/7) and 0% (0/6) for the EETS group, and 57% (57/100) and 18.18% (18/99) for the FC group. According to the previous meta-analysis, stereotactic radiosurgery resulted in remarkable tumor shrinkage in 67.80% (40/59) of patients and partial shrinkage in 25.42% of patients. Discussion The results showed that the intrasellar type of CSHs could be removed safely by EETS without crossing the nerves in the CS.
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Mishra SC, Chaturvedi P, Gupta A, Sharma S. Cavernous haemangioma of cavernous sinus causing diagnostic dilemma: a case report with review of literature. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cavernous haemangioma of the cavernous sinus is an uncommon vascular malformation. It is often confused with other parasellar masses like schwannomas and meningiomas due to overlap in imaging appearance. It is important to pre-operatively diagnose this condition as it is associated with severe intra-operative bleeding.
Case presentation
Here, we report a case of an octogenarian female who presented with left sided progressive ptosis and diminution of vision for one year. Cross-sectional imaging includes computed tomography and magnetic resonance imaging which were not conclusive of cavernous sinus haemangioma. Digital subtraction angiography was done which showed a vascular blush. After corroborating the findings of these imaging investigations, a diagnosis of cavernous sinus haemangioma was concluded. Patient underwent surgery which showed a hypervascular mass. Histopathology was consistent with the imaging diagnosis. Patient was discharged in good stable condition and doing well and is on follow-up in Neurosurgery Out-Patient Department.
Conclusions
The cavernous sinus Haemangiomas are uncommon benign vascular masses. They pose a diagnostic challenge when seen in the parasellar region as the imaging findings of a haemangioma, meningioma and schwannoma in this location can have a significant overlap in the imaging findings. Cross-sectional imaging, digital subtraction angiography and nuclear imaging help in pre-operative diagnosis which is a crucial as the surgery is associated with significant blood loss.
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Osunronbi T, May Myat Noe Pwint P, Usuah J, Cain J, Mathur S, Gurusinghe NT, Roberts GA, Alalade AF. Cavernous sinus haemangioma: systematic review and pooled analysis relating to a rare skull base pathology. Neurosurg Rev 2022; 45:2583-2592. [DOI: 10.1007/s10143-022-01796-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
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Abujarir RH, Ayyad A, Sotouhy A, Bozom E, Shaaban A, Kubaissi AA. Convexity Dura-Based Cerebral Cavernous Malformation Mimicking Meningioma: A Case Report and Literature Review. Asian J Neurosurg 2022; 17:120-126. [PMID: 35873845 PMCID: PMC9298532 DOI: 10.1055/s-0042-1749109] [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] [Indexed: 11/15/2022] Open
Abstract
Cavernous angioma, cavernoma, cavernous hemangioma, also called cerebral cavernous malformation (when present in the brain), are benign vascular malformations, usually intraparenchymal; however, a few reported cases are in the extra-axial location—as middle cranial fossa, near the cavernous sinuses, and in the cerebellopontine angle—and are rarely reported as dura-based convexity lesion resembling meningioma. We report a giant dura-based, convexity, a cerebral cavernous malformation. We wish to notify the case as occurring at a rare location and a large-sized cerebral cavernous malformation. A case of young female presented with a long-standing history of headache. Computed tomography scan and magnetic resonance imagings (MRIs) suggested right occipital dura-based large mass lesion of approximately 5 cm in diameter. The lesion was excised and pathology studies confirmed the diagnosis of a cerebral cavernous malformation. A follow-up MRI confirmed total resection of the lesion and the patient had a smooth postoperative recovery.
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Affiliation(s)
| | - Ali Ayyad
- Neurosurgery Unit, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Sotouhy
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Essam Bozom
- Department of Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Shaaban
- Neurosurgery Unit, Hamad Medical Corporation, Doha, Qatar
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Ibrahim D, El Fiki A, Hafez M, Saleem S. Report of a case of cavernous haemangioma of the cavernous sinus. BJR Case Rep 2020; 5:20190031. [PMID: 31938563 PMCID: PMC6945263 DOI: 10.1259/bjrcr.20190031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/05/2022] Open
Abstract
Cavernous haemangioma of the cavernous sinus is a rare vascular malformation. It's often confused with other parasellar masses. Here, we report a case of a female with a left parasellar mass which was misdiagnosed as schwannoma vs meningioma using CT and MRI. The patient was operated via the pterional approach but resection had been halted due to severe haemorrhage and only tumour biopsy could be obtained. The diagnosis of cavernous sinus haemangioma was established by histopathology and confirmed by subsequent digital subtraction angiography. The patient refused second surgery or adjuvant radiosurgery and the treatment strategy was observation and follow-up. Retrospectively, we included the key radiographic features of cavernous sinus haemangioma which would facilitate pre-operative diagnosis and avoid unforeseen operative complications. Diagnostic radiographic features include a well-defined mass in the cavernous sinus which shows isodense to slightly hyperdense attenuation on non-contrast CT scan with possible adjacent pressure bone remodelling. On MRI, it shows remarkable high T2 signal; intense homogenous enhancement or characteristic progressive contrast enhancement on sequential enhanced images. On digital subtraction angiography, it may demonstrate a vascular blush.
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Affiliation(s)
- Dalia Ibrahim
- Department of Radiology, Lecturer of Radiodiagnosis, Kasr Al Ainy Hospital, Egypt
| | - Ahmed El Fiki
- Department of Neurosurgery, Assistant professor of Neurosurgery, Kasr Al Ainy Hospital, Egypt
| | - Mohamed Hafez
- Professor and head of Neurosurgery department, Kasr Al Ainy Hospital, Egypt
| | - Sahar Saleem
- Department of Radiology, Professor of Radiodiagnosis, Kasr Al Ainy Hospital, Egypt
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7
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Abstract
Cavernous hemangiomas are not true vascular tumors, but rather are slow-flow venous malformations (VMs). They are present at birth as nonproliferating vascular birthmarks composed of anomalous ectatic venous channels. VMs have often been incorrectly called cavernous hemangiomas and cavernous angiomas. These terms have for a long time lead to confusion with the more common proliferating or true hemangioma of infancy. VM has been reported to arise at all sites including skin and subcutaneous layers of the head and neck, face, extremities, liver, gastrointestinal tract, and even the thymus. Although VMs are common intraocular tumors and are involved within intracranial, extraaxial cranial nerves within the cavernous sinus has been sporadically reported, and less often in the supraorbital nerve, an extraocular and extracranial division of the trigeminal nerve has not been reported. The authors present an extremely rare occurrence of VM involving the supraorbital nerve in an 80-year-old female.
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Affiliation(s)
- Jung-Hoon Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jin-Gyu Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Byung-Chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.,Catholic Neuroscience Institute, College of Medicine, Catholic University of Korea, Seoul, Korea
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Tang X, Wu H, Wang B, Zhang N, Dong Y, Ding J, Dai J, Yu T, Pan L. A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases. Acta Neurochir (Wien) 2015; 157:961-9; discussion 969. [PMID: 25862173 DOI: 10.1007/s00701-015-2417-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/26/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cavernous sinus hemangiomas (CaSHs) are rare vascular lesions in the cavernous sinus(CS). Gamma Knife radiosurgery (GKS) provides a treatment modality alternative to microsurgery. This study was conducted to describe a new classification of CaSHs based on their magnetic resonance (MR) imaging findings and determine the efficacy and safety of GKS in a large series of CaSH patients. METHODS From April 2007 to November 2012, 53 patients harboring CaSHs were treated using Leksell Gamma Knife model C (before April 2012) or Perfexion (from May 2012 ) at the Gamma Knife Center of Huashan Hospital. Of the 53 patients, 15 with definitive histopathologic diagnoses after surgery, 38 were diagnosed based on their MR imaging findings. There were 15 male and 38 female patients with a mean age of 52 (range, 25-76) years old. The characteristics of MR images of CaSHs were their extremely high homogeneous intensity on T2-weighted and FLAIR images: as bright as cerebrospinal fluid signal. According to the relationship between the carotid line and their location, CaSHs were classified into three types: the intrasellar, parasellar and mixed type. The mean volume of the tumors was 13.2 ± 8.2 cm(3) (range, 1-41 cm(3)). A mean marginal dose of 13.3 Gy (range, 8-15 Gy) was directed to the 49%-64% isodose line (mean 53%). RESULTS Of the 53 tumors, 6 (11%) were classified as intrasellar type. Eight (15%) were parasellar type and the other 39 cases(74%) mixed type. The mean radiological and clinical follow-up time of this study was 24 (range, 2-67 months) and 34 months (range, 2-73 months), respectively. The tumor control rate was 100%. The mean tumor volume reduction was 79.5% (range, 16.5%-100%) compared with the pre-GKS volume. Six months after GKS, MR imaging revealed an average of 60.2% tumor volume reduction (range, 16.5%-89.2%). Twenty-nine cases (55%) showed a >80% tumor volume decrease. Neurologically, only two of these patients showed clinical deterioration, and 33 patients demonstrated an obvious improvement in ocular or endocrine disorders. At last follow-up, there were no more complications related to GKS, and none of the tumors progressed. CONCLUSIONS Our study showed that GKS is a useful and safe therapeutic method for CaSHs as both a primary and adjuvant treatment. The new classification of CaSHs may help predict their clinical course during tumor development and treatment response after GKS. Further studies with long-term follow-up and larger numbers of cases are necessary to optimize the treatment conditions and verify the benefit of this treatment.
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Abstract
Cavernous sinus hemangiomas are relatively rare but have characteristic imaging features. We present a case of a large extra-axial middle cranial fossa mass arising from the cavernous sinus in a 51-year-old female, and we describe the unique features and complications of this intracranial tumor. With the proper pre-operative diagnosis, an appropriate plan can be created for these highly vascular lesions, minimizing the risks involved with surgery.
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Haber JS, Kesavabhotla K, Ottenhausen M, Bodhinayake I, Dinkin MJ, Segal AZ, Lee YM, Boockvar JA. Conservative management of cavernous sinus cavernous hemangioma in pregnancy. J Neurosurg 2014; 120:1309-12. [PMID: 24724853 DOI: 10.3171/2014.3.jns131756] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cavernous sinus cavernous hemangiomas in pregnancy are extremely rare lesions. The precise management of these lesions remains unknown. The authors present a case of a cavernous hemangioma in pregnancy, centered within the cavernous sinus that underwent postpartum involution without surgical intervention. A 34-year-old pregnant patient (gravida 1, para 0) presented to an otolaryngologist with persistent headache and left-sided facial pain and numbness in the V1 distribution. While being treated for sinusitis, her symptoms progressed to include a left-sided oculomotor palsy and abducens palsy. Magnetic resonance imaging without contrast revealed an expansile mass within the left cavernous sinus consistent with a cavernous hemangioma. The patient was evaluated by a neurosurgeon who recommended close follow-up and postpartum imaging without surgical intervention. Although the lesion enlarged during pregnancy, the patient was able to undergo an uncomplicated cesarean section at 37 weeks. All facial and ocular symptoms resolved by 9 months postpartum, and MRI showed a decrease in lesion size and reduced mass effect. The authors conclude that nonsurgical management may be a viable approach in patients who have an onset or exacerbation of symptoms associated with cavernous sinus cavernous hemangiomas during pregnancy because postpartum involution may negate the need for surgical intervention.
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11
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Derman A, Shields M, Davis A, Knopp E, Fatterpekar GM. Diseases of the Sella and Parasellar Region: An Overview. Semin Roentgenol 2013; 48:35-51. [DOI: 10.1053/j.ro.2012.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fraser JF, Mass AY, Brown S, Anand VK, Schwartz TH. Transnasal endoscopic resection of a cavernous sinus hemangioma: technical note and review of the literature. Skull Base 2011; 18:309-15. [PMID: 19240830 DOI: 10.1055/s-0028-1086059] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Objective/Importance: Hemangiomas of the cavernous sinus are rare lesions. Complete removal through a transcranial route often causes ocular motor palsies. Because the cranial nerves in the cavernous sinus are lateral to the carotid, a medial approach to the cavernous sinus may be less traumatic to the cranial nerves. CLINICAL PRESENTATION A 50-year-old man with headaches, dizziness, diplopia, and magnetic resonance imaging that demonstrated a right cavernous sinus mass expanding into the sella and sphenoid sinus. INTERVENTION A gross total removal of a cavernous sinus hemangioma was performed through an extended endoscopic transsphenoidal approach. CONCLUSION This is the first report of a complete removal of a cavernous sinus hemangioma using an endoscopic transnasal approach. The endoscopic transnasal approach to the medial cavernous sinus may be less traumatic than the transcranial route based on the lateral location of the cranial nerves.
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Affiliation(s)
- Justin F Fraser
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
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13
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Chou CW, Wu HM, Huang CI, Chung WY, Guo WY, Shih YH, Lee LS, Pan DHC. Gamma knife surgery for cavernous hemangiomas in the cavernous sinus. Neurosurgery 2011; 67:611-6; discussion 616. [PMID: 20647963 DOI: 10.1227/01.neu.0000378026.23116.e6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cavernous hemangioma in the cavernous sinus (CS) is a rare vascular tumor. Direct microsurgical approach usually results in massive hemorrhage. Radiosurgery has emerged as a treatment alternative to microsurgery. OBJECTIVE To further investigate the role of Gamma Knife surgery (GKS) in treating CS hemangiomas. METHODS This was a retrospective analysis of 7 patients with CS hemangiomas treated by GKS between 1993 and 2008. Data from 84 CS meningiomas treated during the same period were also analyzed for comparison. The patients underwent follow-up magnetic resonance imaging at 6-month intervals. Data on clinical and imaging changes after radiosurgery were analyzed. RESULTS Six months after GKS, magnetic resonance imaging revealed an average of 72% tumor volume reduction (range, 56%-83%). After 1 year, tumor volume decreased 80% (range, 69%-90%) compared with the pre-GKS volume. Three patients had > 5 years of follow-up, which showed the tumor volume further decreased by 90% of the original size. The average tumor volume reduction was 82%. In contrast, tumor volume reduction of the 84 cavernous sinus meningiomas after GKS was only 29% (P < .001 by Mann-Whitney U test). Before treatment, 6 patients had various degrees of ophthalmoplegia. After GKS, 5 improved markedly within 6 months. Two patients who suffered from poor vision improved after radiosurgery. CONCLUSION GKS is an effective and safe treatment modality for CS hemangiomas with long-term treatment effect. Considering the high risks involved in microsurgery, GKS may serve as the primary treatment choice for CS hemangiomas.
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Affiliation(s)
- Chiang-Wei Chou
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and School of Medicine, National Yang Ming University, Taipei, Taiwan
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HORI S, HAYASHI N, NOMOTO K, SATO H, HAYASHI T, NAGAI S, NISHIKATA M, ENDO S. Cavernous Sinus Cavernous Hemangioma Largely Extending Into the Sella Turcica and Mimicking Pituitary Adenoma -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:330-2. [DOI: 10.2176/nmc.50.330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satoshi HORI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Nakamasa HAYASHI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | | | - Hikari SATO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Tomohide HAYASHI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Shoichi NAGAI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | | | - Shunro ENDO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
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Navas M, Pedrosa-Sánchez M, Martínez-Flórez P, Carrasco R, Pascual J, Sola R. Hemangioma gigante del seno cavernoso. Caso clínico. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70144-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Gonzalez LF, Lekovic GP, Eschbacher J, Coons S, Porter RW, Spetzler RF. Are cavernous sinus hemangiomas and cavernous malformations different entities? Neurosurg Focus 2006; 21:e6. [PMID: 16859259 DOI: 10.3171/foc.2006.21.1.7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cavernous hemangiomas that occur within the cavernous sinus (CS) are different from cerebral cavernous malformations (CMs) clinically, on imaging studies, and in their response to treatment. Moreover, CMs are true vascular malformations, whereas hemangiomas are benign vascular tumors. Because of these differences, the authors suggest that these two entities be analyzed and grouped separately. Unfortunately, despite these differences, much confusion exists in the literature as to the nature, behavior, and classification of these two distinct lesions. This confusion is exacerbated by subtle histological differences and the inconsistent use of nomenclature. The authors use the term "cavernous malformation" to refer to intraaxial lesions only; they prefer to use the term "cavernous sinus hemangioma" to refer to extraaxial, intradural hemangiomas of the CS.
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Affiliation(s)
- L Fernando Gonzalez
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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Abstract
✓The authors present the case of a 60-year-old woman who was admitted to their institution after suffering a subarachnoid hemorrhage (SAH). Neuroimaging data demonstrated an olfactory groove meningioma surrounded by a slight edema, but there was no evidence of SAH, although results of the lumbar puncture demonstrated xanthochromic cerebrospinal fluid. Angiography confirmed the diagnosis of meningioma, but results of magnetic resonance imaging led the authors to suspect a cavernoma within the meningioma. This diagnosis was established by pathological examination of the resected lesion. The patient did well and was discharged soon after surgery. This very rare association and the propensity of each of these lesions to be revealed by hemorrhage are discussed.
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Affiliation(s)
- Olivier Klein
- Department of Neurosurgery, Hôpital Central, Nancy, France.
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18
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Goel A, Muzumdar D, Sharma P. Extradural approach for cavernous hemangioma of the cavernous sinus: experience with 13 cases. Neurol Med Chir (Tokyo) 2003; 43:112-8; discussion 119. [PMID: 12699117 DOI: 10.2176/nmc.43.112] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The clinical, radiological, and surgical issues concerning cavernous hemangiomas located within the dural confines of the cavernous sinus were analyzed on the basis of experience with 13 cases. The feasibility of radical resection by an entirely extradural approach using a basal temporal surgical route to this relatively rare and formidable surgical problem was investigated. Thirteen patients, four males and nine females, with cavernous hemangioma involving the cavernous sinus were treated from 1992 to 2001. The patients were aged from 15 to 55 years. Headaches and deficits of the cranial nerves coursing through the cavernous sinus were the principal symptoms at presentation. Vision was affected in four patients. The radiological features in all patients were similar with a characteristic pattern of extension and encasement of internal carotid artery. The maximum size of the tumor was 28 to 73 mm (mean 44 mm). An entirely extradural route using the basal temporal approach was used successfully in seven cases. Total resection was achieved in 12 patients and partial resection was achieved in one patient. The follow up ranged from 8 months to 9 years (mean 45 months). The outcome of extraocular movements was poor in our series, possibly due to the massive sizes of the tumors encountered. There was no recurrence or growth of the residual tumor and all patients were leading active lives.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
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19
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Kida Y, Kobayashi T, Mori Y. Radiosurgery of cavernous hemangiomas in the cavernous sinus. SURGICAL NEUROLOGY 2001; 56:117-22; discussion 122-3. [PMID: 11580951 DOI: 10.1016/s0090-3019(01)00537-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cavernous hemangiomas in the cavernous sinus are rare and demonstrate unique clinical courses. Although they rarely cause spontaneous bleeding, serious bleeding is not uncommon during operations. Total eradication of such tumors is very difficult because of the location and intraoperative bleeding. Consequently, alternatives to operative resection have been examined. METHODS Three cases of cavernous hemangiomas in the cavernous sinus, presenting chiefly with ocular signs and facial pain, were treated by radiosurgery using a gamma knife. Two of the patients had been operated on before radiosurgery, while the third patient was diagnosed on the basis of neurological signs as well as radiological findings. RESULTS MRI scans at the time of radiosurgery showed tumors in the cavernous sinus with low or iso-intensity on T1-weighted images and high signal intensity on T2-weighted images. All of the tumors intensely enhanced with gadolinium-DTPA. The tumors had diameters of 14 to 28 mm and were treated with a marginal dose of 14 to 17 Gy (mean 15.7 Gy). In the mean follow-up period of 27 months after radiosurgery, all of the tumors decreased in size (PR). Neurologically, none of the patients showed any deterioration, and one demonstrated an obvious improvement in ocular movement. CONCLUSIONS Radiosurgery for cavernous hemangioma in the cavernous sinus is apparently safe and effective with consistent tumor shrinkage. Therefore, radiosurgery is an excellent alternative to operative intervention and may even replace operative procedures if the tumors are small in diameter or when they recur.
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Affiliation(s)
- Y Kida
- Department of Neurosurgery, Komaki City Hospital, Komaki City, Japan
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