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Bhattacharjee K, Rehman O, Venkatraman V, Das D, Mohapatra SSD, Gogoi R, Soni D. Blood within the bone: orbital intraosseous venous malformation. Orbit 2024; 43:316-328. [PMID: 38261337 DOI: 10.1080/01676830.2024.2303761] [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: 10/25/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Description of clinical features, radiological characteristics, and management strategies in primary orbital intraosseous venous malformation (OIVM) with pertinent literature review. METHODS A retrospective analysis including clinical, radiologic, operative, and histopathological data of six cases of histopathologically proven OIVM was done. A comprehensive literature review was conducted using online databases and augmented with manual search to identify reported cases of OIVM. RESULTS Study data showed five females and one male in young to middle-age group, with an average age of 30 years (range: 20-48 years). Proptosis was noted in five cases (83.33%), and the duration of symptoms ranged from 6 months to 10 years. Frontal and zygomatic bones were most frequently affected and expansile bony lesion was the most common CT scan finding. Three patients underwent pre-operative embolization of feeders followed by en bloc excision of mass and surgical reconstruction (50%); one patient was managed with partial excision (16.66%) while two were regularly followed-up after incision biopsy (33.33%). Histopathology revealed vascular spaces with endothelial lining, separated by bony trabeculae in all patients. Follow-up periods ranged from 6 to 48 months and no recurrence or progression were noted. CONCLUSIONS OIVM is an exceptionally rare disorder with a gradually progressive benign course. Ophthalmologists need to be mindful of this entity during patient evaluation as it has propensity for large volume blood loss intra-operatively, owing to its vascular nature. Complete excision with reconstruction of resultant defect is the preferred treatment strategy and without known recurrence.
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Affiliation(s)
- Kasturi Bhattacharjee
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Obaidur Rehman
- Department of Oculoplasty and Ocular Oncology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Vatsalya Venkatraman
- Department of Oculoplasty, Ocular Oncology and Facial Aesthetics, ASG Eye Hospital, Jodhpur, India
| | - Dipankar Das
- Department of Ocular Pathology, Uveitis and Neuro-Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Shyam Sundar Das Mohapatra
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Rahul Gogoi
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Deepak Soni
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
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Waldman S, Shimonov M, Yang N, Spielman D, Godfrey KJ, Dean KE, Phillips CD, Helman SN. Benign bony tumors of the paranasal sinuses, orbit, and skull base. Am J Otolaryngol 2022; 43:103404. [PMID: 35246319 DOI: 10.1016/j.amjoto.2022.103404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 11/15/2022]
Abstract
Benign bony tumors of the skull base and paranasal sinuses are uncommon entities, with an overall higher incidence in males. Benign bony tumors may lead to local expansion with resultant mass effect of potentially critical structures. Some benign bony tumors may undergo malignant transformation. This article reviews the presentation and management of benign bone tumors of the skull base and paranasal sinuses with special consideration to involvement of the adjacent orbit, intracranial and critical neurovascular structures. This review covers tumor incidence, location, gross and histologic appearance as well as radiographic findings, treatment, and recurrence rates. Tumors discussed in this article include osteochondromas, osteomas, osteoid osteomas, aneurysmal bone cysts, fibrous dysplasia, giant cell tumors, cemento-ossifying fibroma, ameloblastic fibro-odontoma, ecchordosis physaliphora, chondromyxoid fibroma, primary chronic osteomyelitis, primary chronic osteomyelitis, osteochondromyxoma, and dense bone islands.
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Affiliation(s)
- Spencer Waldman
- SUNY Downstate, College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America.
| | - Menachem Shimonov
- SUNY Downstate, College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America.
| | - Nathan Yang
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
| | - Daniel Spielman
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
| | - Kyle J Godfrey
- Weill Cornell Medical College, Department of Ophthalmology--1305 York Ave, 12(th) Floor New York, NY 10021, United States of America.
| | - Kathryn E Dean
- Weill Cornell Imaging at New York-Presbyterian 1305 York Avenue,3rd Floor, New York, NY 10021, United States of America.
| | - C Douglas Phillips
- Weill Cornell Imaging at New York-Presbyterian 1305 York Avenue,3rd Floor, New York, NY 10021, United States of America.
| | - Samuel Nathaniel Helman
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
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Nagamine K, Kanaya K, Miyairi Y, Ogiso Y, Shigeta H. Aggressive growing of the infantile cavernous hemangioma of the calvaria: a case report and review of literature. Childs Nerv Syst 2021; 37:319-323. [PMID: 32435889 DOI: 10.1007/s00381-020-04678-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Primary intraosseous cavernous hemangiomas of the skull are very rare in the pediatric age group and usually slow-growing tumors. CASE REPORT We present a case of 5-month-old girl with a left occipital cavernous hemangioma that is rapidly growing. The subcutaneous occipital tiny mass was first noted at birth, and the lesion became rapidly enlarged in size and became soft for 3 months. The left occipital subcutaneous lesion was 4.0 × 4.0 × 2.0 cm (AP × LR × HT) in size. There was no history of trauma or bone tumor in her family. She underwent resection of the lesion, and a pathologic diagnosis of calvarial cavernous hemangioma was made. No recurrence was seen 1 year after surgery. CONCLUSION The rapid growth of the infant cavernous hemangioma might be related to not only bleeding and/or congestion of the lesion but the immature thin skull of the infant.
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Affiliation(s)
- Kohei Nagamine
- Department of Neurosurgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino, 399-8288, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino, 399-8288, Japan.
| | - Yosuke Miyairi
- Department of Neurosurgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino, 399-8288, Japan
| | - Yoshifumi Ogiso
- Department of Clinical Laboratory, Nagano Children's Hospital, Azumino, Japan
| | - Hiroaki Shigeta
- Department of Neurosurgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino, 399-8288, Japan
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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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Abstract
A primary intraosseous hemangioma (IOH) of the orbital bone is extremely rare. The preferred method of treatment for IOH is total surgical excision with reconstruction. Herein, the authors describe a patient with an orbital roof IOH and the unexpected complications of ptosis and deteriorated exophthalmos. These findings showed that the total surgical excision and subsequent reconstruction provided adequate decompression and prevented further ocular complications from the orbital wall defect.
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Mohindra S, Kapoor A, Mitra S, Nahar U. Giant primary calvarial hemangioma over torcula: Radiological features and operative nuances. Surg Neurol Int 2016; 7:S440-3. [PMID: 27308094 PMCID: PMC4901819 DOI: 10.4103/2152-7806.183544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/15/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although rare, primary calvarial hemangioma is a known entity, surgical excision of which usually results in massive blood loss. Successful total excision of such a lesion remains a challenge, especially when these are in close vicinity of major venous sinuses. CASE DESCRIPTION Authors describe a rare case of intra-osseous occipital cavernoma along with radiological findings in a 50-year-old male. En bloc resection of tumor was performed using a high-speed pneumatic drill and no recurrence was noted at 6 months of follow-up. CONCLUSION Intra-osseous cavernous hemangiomas have classical radiological features and can be excised completely, even when lying above major venous drainage channels like torcula.
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kapoor
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvradeep Mitra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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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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Serrano L, Archavlis E, Januschek E, Ulrich PT. High risk of cerebrospinal fluid leakage in surgery of a rare primary intraosseous cavernous hemangioma of the clivus showing meningeal infiltration: A case report and review of the literature. Surg Neurol Int 2015; 6:S117-23. [PMID: 25949853 PMCID: PMC4408619 DOI: 10.4103/2152-7806.155695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/27/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary intraosseous cavernous hemangiomas (PICH) of the skull represent an infrequent bone tumor. Although some rare cases of PICHs located in the skull base have been published, to our concern only three cases have been reported in the English literature of PICHs arising within the clivus. CASE DESCRIPTION We present the case of a patient presenting an isolated abducens paresis due to a rare PICH of the clivus showing also an unusual destruction of the inner table as well as infiltration of the dura mater. Due to this uncommon infiltrative pattern of an otherwise expected intraosseous tumor, a cerebrospinal fluid (CSF)-fistula occurred while performing a transnasal biopsy. The patient recovered successfully without need of lumbar drainage or re-surgery. Additionally, intratumoral decompression was sufficient to relief the abducens paresis. CONCLUSIONS Our case provides new and meaningful information about clinical features as well as growth pattern of these rare clival tumors. We also discuss the importance of knowing these peculiarities before surgery in order to plan the optimal operative management as well as to avoid complications while approaching PICHs localized in such a delicate cranial region.
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Affiliation(s)
- Lucas Serrano
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
| | - Eleftherios Archavlis
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
| | - Elke Januschek
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
| | - Peter T Ulrich
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
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Werdich XQ, Jakobiec FA, Curtin HD, Fay A. A clinical, radiologic, and immunopathologic study of five periorbital intraosseous cavernous vascular malformations. Am J Ophthalmol 2014; 158:816-826.e1. [PMID: 25034115 DOI: 10.1016/j.ajo.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To correlate the clinical, radiographic, histopathologic, and immunohistochemical features of 5 primary periorbital intraosseous cavernous vascular malformations. DESIGN Retrospective interventional case series. METHODS Clinical and operative records and radiographic images were reviewed. Histopathologic slides were evaluated with hematoxylin-eosin, trichrome, and elastin stains. Immunohistochemical studies were performed with a spectrum of monoclonal antibodies directed at antigens of vascular cells. RESULTS Three men and 2 women ranged in age from 36 to 64 years. Vision was unaffected and there was no proptosis or globe displacement. The slow-growing lesions measured 13-25 mm in greatest diameter (mean 16.4 mm). Computed tomographic studies revealed that 2 lesions were situated in the maxillary bone, 2 in the frontal, and 1 in the zygoma, all anteriorly and with circumscribed, lucent, honeycombed, or sunburst characteristics. Histopathologically the lesions were composed of cavernous or telangiectatic channels; 1 showed advanced fibrotic vascular involution. Immunohistochemistry demonstrated CD31/34 positivity for vascular endothelium and D2-40 negativity for lymphatic endothelium. A typically thin mural myofibroblastic cuff was smooth muscle actin positive, weakly calponin positive, and desmin negative. Glucose transporter-1 and Ki-67 were negative in the endothelium. CONCLUSIONS Intraosseous vascular lesions resemble orbital cavernous venous malformations (not true hemangiomas), except that their vascular walls are thinner owing to the constraints imposed by neighboring bone spicules, which limit the amount of interstitium from which mural myofibroblasts can be recruited. The bony trabeculae conferred the honeycomb or sunburst appearances observed radiographically. En bloc excision of these lesions was successful and avoided complications (mean follow-up, 46 months).
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Affiliation(s)
- Xiang Q Werdich
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Hugh D Curtin
- Department of Radiology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Aaron Fay
- Ophthalmic Plastic Surgery, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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10
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Gologorsky Y, Shrivastava RK, Panov F, Mascitelli J, Signore AD, Govindaraj S, Smethurst M, Bronster DJ. Primary intraosseous cavernous hemangioma of the clivus: case report and review of the literature. J Neurol Surg Rep 2013; 74:17-22. [PMID: 23943715 PMCID: PMC3713557 DOI: 10.1055/s-0033-1346980] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 02/19/2013] [Indexed: 11/03/2022] Open
Abstract
Primary intraosseous hemangiomas are benign, vascular malformations that account for approximately 1% of all primary bone neoplasms. These tumors are mostly found in vertebral bodies and are rarely seen in the calvarium, where they represent 0.2% of bony neoplasms. When found in the skull, they tend to present with vague symptoms and do not have the typical radiological findings suggestive of hemangiomas. Because of this, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. Involvement of the skull base is exceedingly rare, and presentation with cranial nerve unilateral polyneuropathies has not been reported. We report a patient case with review of recent pertinent literature.
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Affiliation(s)
- Yakov Gologorsky
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA
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11
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Rumana M, Khursheed N, Farhat M, Othman S, Masood L. Congenital intraosseous cavernous hemangioma of the skull: an unusual case. Pediatr Neurosurg 2013; 49:229-31. [PMID: 25060919 DOI: 10.1159/000363328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/30/2014] [Indexed: 11/19/2022]
Abstract
Intraosseous hemangiomas are benign vascular malformations mostly seen in the spine. They rarely occur in the skull. The usual age-group involved is the 2nd to 4th decades, and females outnumber males. We hereby report a rare case of congenital intraosseous cavernous hemangioma of the skull bone in a male infant. The patient underwent total excision of the lesion.
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Affiliation(s)
- Makhdoomi Rumana
- Department of Pathology, Sheri-Kashmir Institute of Medical Sciences, Kashmir, India
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12
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Abstract
Primary orbital bone tumors account for 0.6-2% of all orbital tumors. This is a heterogeneous group of tumors arising from osseous, cartilaginous, fibrous, and vascular tissues. The two most commonly encountered lesions are fibrous dysplasia and osteoma. Treatment of the primitive orbital bone tumors is generally surgical.
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Nasrallah IM, Hayek R, Duhaime AC, Stotland MA, Mamourian AC. Cavernous hemangioma of the skull: surgical treatment without craniectomy. J Neurosurg Pediatr 2009; 4:575-9. [PMID: 19951047 DOI: 10.3171/2009.7.peds09105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a large cranial cavernous hemangioma that was treated using embolization and craniotomy with preservation of the outer cranial table. A 3-year follow-up demonstrated no recurrence. Results in this case suggest that cavernous hemangiomas of the cranium may be safely and effectively treated without craniectomy in some cases.
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Affiliation(s)
- Ilya M Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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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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Gordhan A, Soliman J, Malpani A, Peg E. Symptomatic calvarial cavernous hemangioma: presurgical confirmation by scintigraphy. J Radiol Case Rep 2009; 3:25-9. [PMID: 22470679 DOI: 10.3941/jrcr.v3i8.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemangiomas are rare tumors in the calvarium and represent 2% of osseous calvarial lesions. Dynamic Tc-99m RBC blood pool scintigraphy has a high positive predictive value for cavernous hemangiomas of the liver. This scintigraphic technique can be used for identifying cavernous hemangiomas at other anatomic sites. We present a case in which a tagged RBC blood pool scan was used for further characterizing a symptomatic calvarial lesion as a cavernous hemangioma. This avoided an unnecessary workup for metastatic disease and was valuable in surgical planning for anticipated increased intra-operative blood loss. Histological confirmation of a cavernous hemangioma was made after surgical resection.
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Affiliation(s)
- Ajeet Gordhan
- Department of Radiology, OSF St Joseph Medical Center, Bloomington, IL, USA
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Naama O, Gazzaz M, Akhaddar A, Belhachmi A, Asri A, Elmostarchid B, Elbouzidi A, Kadiri B, Boucetta M. Cavernous hemangioma of the skull: 3 case reports. SURGICAL NEUROLOGY 2008; 70:654-659. [PMID: 18207223 DOI: 10.1016/j.surneu.2007.05.052] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 05/18/2007] [Indexed: 05/25/2023]
Abstract
BACKGROUND Intraosseous cavernous hemangiomas of the bone are uncommon tumors, accounting for 0.7% to 1% of all bone neoplasms. The vertebral column is most often affected, followed by the skull. Calvarial cavernous hemangioma is rare, comprising about 0.2% of all benign neoplasms of the skull. CASES REPORTS We describe 3 patients with calvarial hemangiomas that were localized frontally (2 cases) and parietally. The diameter ranged from 2 to 3 cm. They presented with slowly growing mass, hard to pressure, with freely mobile skin above the cavernoma sites. Cranial CT scan showed osteolytic lesion with erosion of the tabula externa. Magnetic resonance imaging performed in one patient showed hypointense lesion on T1-weighted image and hyperintense on T2-weighted image. Resection and postoperative course were uneventful. Pathological examination revealed a cavernous hemangioma of the diploe. CONCLUSION Skull cavernous hemangiomas are rare benign tumors. The preferred treatment is complete tumor removal with normal bony margins. Sometimes, the classic radiographic appearances are not evident. Consequently, the diagnosis is most often made during surgical resection.
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Affiliation(s)
- Okacha Naama
- Department of Neurosurgery, Mohammed V Military Hospital, Rabat 56987, Morocco.
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18
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Reis BL, Carvalho GTC, Sousa AAD, Freitas WBD, Brandão RACS, Brandão RACS, Santiago RADC. Primary hemangioma of the skull. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:569-71. [PMID: 18813725 DOI: 10.1590/s0004-282x2008000400029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Baltazar Leão Reis
- Neurosurgery Service, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil.
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Stamataki S, Francis HW, Holliday M, McCarthy E. Histological features of osteofibrous hemangioma of the maxillofacial and skull base regions. Otolaryngol Head Neck Surg 2008; 138:587-93. [PMID: 18439463 DOI: 10.1016/j.otohns.2008.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 12/26/2007] [Accepted: 01/07/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The histological spectrum of hemangiomas of the skull base and maxillofacial skeleton was evaluated to help explain the variability of the clinical and radiological presentation of this tumor. DESIGN Retrospective case series. PARTICIPANTS Patients with surgically treated hemangiomas of the ear, sinuses, skull base, and maxillofacial bones. METHOD Light microscopic appearance of surgical specimens. RESULTS Review of specimens from 23 tumors revealed two distinct histological patterns: 1) typical histology consisting of vascular spaces lined by endothelium and a thin layer of smooth muscle, and 2) osteofibrous histology that consisted of prominent fibrous tissue between vascular spaces associated occasionally with neo-osseogenesis. The osteofibrous histology was more prevalent in the sinonasal and anterior skull base regions compared to the internal auditory canal. CONCLUSIONS Connective tissue and bony proliferation within hemangiomas vary according to tumor location and may have implications for the radiological appearance, ease of surgical resection, and associated morbidity.
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Affiliation(s)
- Sofia Stamataki
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
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Nasser K, Hayashi N, Kurosaki K, Hasegawa S, Kurimoto M, Mohammed A, Endo S. Intraosseous cavernous hemangioma of the frontal bone. Neurol Med Chir (Tokyo) 2007; 47:506-8. [PMID: 18037805 DOI: 10.2176/nmc.47.506] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 32-year-old man presented with a primary intraosseous cavernous hemangioma manifesting as a small painless swelling of the right forehead. Radiography revealed a radiolucent osteolytic lesion in the right frontal region. Bone window computed tomography demonstrated a 1.5 cm mass between the outer and inner tables just lateral to the right frontal sinus. The outer and inner tables were thin and partially defective, but without bone fracture. Magnetic resonance imaging revealed a small mass lesion with bone erosion of the posterior table of the frontal bone. Preoperative examination yielded no final diagnosis. En bloc resection was performed. The histological diagnosis was primary intraosseous cavernous hemangioma. Total resection is recommended for definitive diagnosis of intraosseous tumor.
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Affiliation(s)
- Khaled Nasser
- Department of Neurosurgery, Faculty of Medicine, Sohag University, Sohag, Egypt
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21
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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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22
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Torres-Carranza E, García-Perla A, Infante-Cossío P, Acosta-Feria M, Belmonte-Caro R, Gutiérrez-Pérez J. Hemangioma intraóseo primario de la órbita: a propósito de dos casos. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70276-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Riveros LG, Simpson ER, DeAngelis DD, Howarth D, McGowan H, Kassel E. Primary intraosseous hemangioma of the orbit: an unusual presentation of an uncommon tumor. Can J Ophthalmol 2006; 41:630-2. [PMID: 17016539 DOI: 10.1016/s0008-4182(06)80037-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CASE REPORT An asymptomatic patient was referred for assessment of an intraocular amelanotic mass in her left eye. Examination showed a mass effect in the inferior location at the 5 o'clock position. This abnormality was defined with ultrasound biomicroscopy and standard ultrasound, but because the appearance was not typical of a melanoma or other choroidal infiltrate, magnetic resonance images and computed tomograms of the orbits were obtained, identifying an extraocular mass arising from the zygomatic rim. Results of a biopsy reported an intraosseous hemangioma. COMMENTS The diagnosis of intraosseous hemangioma, because of its low incidence and unusual manner of presentation, can be challenging. Computed tomography and biopsy are helpful in making a definitive diagnosis.
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Affiliation(s)
- Luis G Riveros
- Ocular Oncology Clinic, Department of Ophthalmology, Princess Margaret Hospital, UHN, Toronto, Ontario, Canada.
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24
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Jeong WJ, Rhee CS. Primary intraosseous orbital hemangioma of the lacrimal bone. Jpn J Ophthalmol 2006; 50:189-90. [PMID: 16604402 DOI: 10.1007/s10384-005-0283-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 04/11/2005] [Indexed: 10/24/2022]
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25
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Dörner L, Buhl R, Hugo HH, Jansen O, Barth H, Mehdorn HM. Unusual locations for cavernous hemangiomas: report of two cases and review of the literature. Acta Neurochir (Wien) 2005; 147:1091-6; discussion 1096. [PMID: 16052290 DOI: 10.1007/s00701-005-0567-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 05/24/2005] [Indexed: 11/28/2022]
Abstract
Cavernous hemangiomas are most commonly found within the subcortical neural parenchyma near the fissura Rolandi, in the basal ganglia, or in the brain stem. Because of advancing neuro-imaging technology and thus resulting in a higher incidence of cavernous hemangiomas they have rising impact in neurosurgery. We present two unusual cases of extra-axial cavernous hemangiomas: one located at the frontal falx, the other within the bone of the right frontal bone. We discuss these and other cases in the literature with respect to the more common differential diagnoses and the appropriate therapy regimen for cavernous hemangiomas in these locations.
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Affiliation(s)
- L Dörner
- Department of Neurosurgery, University of Schleswig Holstein Campus Kiel, Kiel, Germany.
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26
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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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27
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Abstract
PURPOSE To report the clinical and radiologic features of two patients with intraosseous orbital hemangiomas of the lateral wall. METHODS Case reports and literature review. RESULTS The first patient presented with an indolent mass over the lateral orbital rim. Intraosseous hemangioma was not considered in the differential diagnosis. A biopsy specimen was taken from the tumor, which caused significant bleeding. After biopsy, an orbital CT scan revealed a lesion involving the left lateral orbital rim and soft tissue of the temporal fossa. The rim was grossly enlarged, with several cavities of different sizes. The tumor of the second patient was located more posteriorly and extended into the roof. The patient complained of parietal headache, epiphora, and local pain. A CT scan revealed a round, lytic lesion involving the greater sphenoid wing and frontal bone. The tumor was approached through a coronal flap and resected en bloc without problems. CONCLUSIONS The diagnosis of intraosseous hemangioma can be difficult, especially when tumors are located in the anterior part of the lateral wall. In this location, intraosseous hemangiomas tend to induce few symptoms and thus have a higher likelihood of biopsy being performed before a correct diagnosis. A CT scan with bone windows can play a beneficial role in the evaluation of lytic bone lesions in intraosseous hemangioma.
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Affiliation(s)
- Gilmasa Daniele Rios Dias
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Clinicas-Campus, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brazil
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28
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Liu JK, Burger PC, Harnsberger HR, Couldwell WT. Primary Intraosseous Skull Base Cavernous Hemangioma: Case Report. Skull Base 2003; 13:219-228. [PMID: 15912181 PMCID: PMC1131855 DOI: 10.1055/s-2004-817698] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary intraosseous cavernous hemangiomas (PICHs) of the skull base are extremely rare tumors. These lesions are most common in the frontal and parietal bones of the calvarium. The authors describe a 40-year-old female who presented with progressive headaches. Serial imaging revealed a contrast-enhancing intraosseous lesion of the lateral body of the sphenoid bone and the greater wing associated with encroachment of the inferior cavernous sinus and mild posterior displacement of the cavernous carotid artery. Follow-up imaging 9 years later revealed slow growth of the lesion. The patient underwent complete excision of the PICH through an extradural frontopolar approach. Pathological examination revealed an intraosseous cavernous hemangioma. PICHs of the skull base can mimic other more common skull base lesions and thus can be difficult to diagnose preoperatively. Diagnosis is usually made at surgery. The authors review the literature regarding the clinical presentation, radiological characteristics, pathological features, and surgical management of PICHs.
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Affiliation(s)
- James K. Liu
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Peter C. Burger
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - H. Ric Harnsberger
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - William T. Couldwell
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
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29
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Shankar A, Daniel RT, Walter N, Chandy MJ. Heterotopic ossification in the orbit. SURGICAL NEUROLOGY 2002; 58:421-3; discussion 424. [PMID: 12517629 DOI: 10.1016/s0090-3019(02)00874-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While calcification of orbital hemangiomas has been reported previously, no reports exist of heterotopic ossifications occurring within the orbit. CASE DESCRIPTION A 30-year-old male presented with spontaneous onset of painless progressive proptosis of the left eye, with diplopia. The preoperative radiologic findings are presented. The lesion was excised completely. The pathologic features and probable causes are discussed. CONCLUSIONS Heterotopic ossification of the orbit should be considered in the differential diagnosis of an orbital lesion showing radiologic features of calcification or ossification.
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Affiliation(s)
- A Shankar
- Department of Neurosurgery, Christian Medical College and Hospital, Vellore--632004, Tamil Nadu, India
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30
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Suzuki Y, Ikeda H, Matsumoto K. Neuroradiological features of intraosseous cavernous hemangioma--case report. Neurol Med Chir (Tokyo) 2001; 41:279-82. [PMID: 11396309 DOI: 10.2176/nmc.41.279] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 40-year-old man presented to our hospital because of a painless lump on his right forehead. Radiography showed a radiolucent defect in the frontal bone. Bone window computed tomography demonstrated a lucent mass which expanded externally from the diploë destroying and passing through the outer plate. T1-weighted magnetic resonance imaging revealed the lesion as non-homogeneously isointense, and T2-weighted imaging as non-homogeneously hyperintense. The lesion was enhanced non-homogeneously after contrast administration. The lesion was subtotally removed. Histological examination suggested cavernous hemangioma. Preoperative examinations could not provide a definitive diagnosis, which was established by the operative finding. Because of the difficulty of diagnosis in the early stage, surgical treatment in the early stage is recommended for total removal and definitive diagnosis of intraosseous tumor.
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Affiliation(s)
- Y Suzuki
- Department of Neurosurgery, SECOMEDIC Hospital, Funabashi, Chiba
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31
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Slaba SG, Karam RH, Nehme JI, Nohra GK, Hachem KS, Salloum JW. Intraosseous orbitosphenoidal cavernous angioma. Case report. J Neurosurg 1999; 91:1034-6. [PMID: 10584852 DOI: 10.3171/jns.1999.91.6.1034] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary orbital intraosseous angiomas are rare. The authors report the case of a 55-year-old man who harbored a multifocal cavernous angioma in an unusual sphenoorbital location. The lesion was responsible for unilateral exophthalmos and blindness. Characteristic imaging findings, which included a honeycomb pattern on plain x-ray films and computerized tomography scans, a heterogeneous high signal intensity on T2-weighted magnetic resonance images, and slowly flowing venous lakes on power Doppler ultrasonograms and angiograms, are presented and discussed.
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Affiliation(s)
- S G Slaba
- Notre-Dame-des-Secours Hospital, Byblos, Lebanon.
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Sharma RR, Pawar SJ, Lad SD, Netalkar AS, Musa MM. Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia. Clin Neurol Neurosurg 1999; 101:215-9. [PMID: 10536912 DOI: 10.1016/s0303-8467(99)00047-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary intraosseous cranial hemangiomas are rare benign tumors comprising 0.2% of all osseous neoplasms. Symptomatic cranial cryptic hemangiomas are extremely rare. We report the case of a 43-year-old man with a cryptic hemangioma of the superior orbital rim. Radiological investigations revealed it to be an intraosseous cryptic mass which was totally excised and the supraorbital nerve was decompressed, relieving the patient of his symptoms. Histopathology showed features of an intraosseous hemangioma.
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Affiliation(s)
- R R Sharma
- The National Neurosurgical Centre, Khoula Hospital, Muscat, Oman.
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