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Cho JM, Sung KS, Jung IH, Chang WS, Jung HH, Chang JH. Temporal Volume Change of Cavernous Sinus Cavernous Hemangiomas after Gamma Knife Surgery. Yonsei Med J 2020; 61:976-980. [PMID: 33107242 PMCID: PMC7593097 DOI: 10.3349/ymj.2020.61.11.976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022] Open
Abstract
Cavernous hemangiomas occur very rarely in the cavernous sinus. This study aimed to evaluate the efficacy of Gamma Knife surgery (GKS) on cavernous sinus cavernous hemangioma (CSCH) and to analyze the temporal volume change. We retrospectively reviewed the clinical data of 26 CSCH patients who were treated with GKS between 2001 and 2017. Before GKS, 11 patients (42.3%) had cranial neuropathies and 5 patients (19.2%) complained of headache, whereas 10 patients (38.5%) were initially asymptomatic. The mean pre-GKS mass volume was 9.3 mL (range, 0.5-31.6 mL), and the margin dose ranged from 13 to 15 Gy according to the mass volume and the proximity to the optic pathway. All cranial neuropathy patients and half of headache patients showed clinical improvement. All 26 patients achieved mass control; remarkable responses (less than 1/3 of the initial mass volume) were shown in 19 patients (73.1%) and moderate responses (more than 1/3 and less than 2/3) in 7 patients (26.9%). The mean final mass volume after GKS was 1.8 mL (range, 0-12.6 mL). The mean mass volume at 6 months after GKS was 45% (range, 5-80%) compared to the mass volume before GKS and 21% (range, 0-70%) at 12 months. The higher radiation dose tended to induce more rapid and greater volume reduction. No treatment-related complication was observed during the follow-up period. GKS could be an effective and safe therapeutic strategy for CSCH. GKS induced very rapid volume reduction compared to other benign brain tumors.
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Affiliation(s)
- Jin Mo Cho
- Department of Neurosurgery, International St Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - In Ho Jung
- Department of Neurosurgery, Yonsei University Health System, Seoul, Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University Health System, Seoul, Korea
- Gamma Knife Center, Yonsei University Health System, Seoul, Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University Health System, Seoul, Korea
- Gamma Knife Center, Yonsei University Health System, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University Health System, Seoul, Korea
- Gamma Knife Center, Yonsei University Health System, Seoul, Korea
- Brain Tumor Center, Yonsei University Health System, Seoul, Korea.
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Young SM, Kim KH, Kim YD, Lang SS, Park JW, Woo KI, Lee JI. Orbital apex venous cavernous malformation with optic neuropathy: treatment with multisession gamma knife radiosurgery. Br J Ophthalmol 2019; 103:1453-1459. [PMID: 30612095 DOI: 10.1136/bjophthalmol-2018-312893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/22/2018] [Accepted: 11/24/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of multisession gamma knife radiosurgery (GKRS) for orbital apex venous cavernous malformation causing optic neuropathy. METHODS Retrospective cohort study in a single tertiary institution from January 2007 to December 2016 on patients who underwent multisession GKRS for orbital apex venous cavernous malformations causing optic neuropathy. RESULTS There were 12 patients included in our study. The mean age was 40.2±14.5 years, and men comprised 66.7% (n=8). Decrease in visual acuity (83.3%) was the most common symptom at presentation. The mean clinical follow-up was 28.5 months. Ten (83.3%) of the 12 patients had improvement in best corrected visual acuity. Of the 10 patients with pre-existing relative afferent pupillary defect (RAPD), 6 (60%) had complete resolution of RAPD. Of the 12 patients with visual field defect, 7 (58.3%) had complete resolution, 3 (25%) had partial improvement, while 2 (16.7%) remained unchanged due to optic atrophy from long-standing compressive optic neuropathy. Mean proptosis reduced from 2.3±1.7 mm pre-GKRS to 0.5±1.3 mm post-GKRS (p=0.005). Tumour shrinkage was observed in all patients. The mean tumour volume at the time of GKRS was 3104 mm3 (range 221-8500 mm3), which reduced to 658 mm3 (range 120-3350 mm3) at last follow-up. None of the patients experienced GKRS-related ocular morbidity during the follow-up period. CONCLUSION Multisession GKRS has shown to be an effective and safe option for the treatment of orbital apex venous cavernous malformations causing optic neuropathy, with significant improvement in ophthalmic outcomes and reduction in tumour volume.
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Affiliation(s)
| | - Kyung Hwan Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Stephanie S Lang
- Clinical Audit, Singapore National Eye Centre, Singapore, Singapore
| | - Ji Woong Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung In Woo
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Wang KY, Idowu OR, Lin DDM. Radiology and imaging for cavernous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:249-266. [PMID: 28552147 DOI: 10.1016/b978-0-444-63640-9.00024-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cavernous malformations are low-flow vascular malformations that are histologically characterized by the lack of mural elements of mature vascular structures and intervening parenchymal neural tissue. They are often clinically quiescent, and may grow, bleed, and regress, but can also manifest clinically as neurologic deficits or seizures in the setting of an acute hemorrhage. The low-flow nature of cavernous malformations renders them inherently occult on cerebral angiography. Magnetic resonance imaging has become the mainstay imaging modality in evaluating cavernous malformations, producing characteristic imaging features that usually provide a straightforward diagnosis. Features on magnetic resonance imaging include a reticulated pattern of mixed hyper- and hypointensity on T1- and T2-weighted imaging, with a characteristic hypointense rim best appreciated on T2-weighted imaging or gradient-echo sequences. Contrast enhancement is useful for revealing coexisting developmental venous anomalies that are frequently associated with sporadic cavernous malformations, and may further support the diagnosis. Susceptibility-weighted imaging is highly sensitive for cavernous malformations and accompanying developmental venous anomalies, and is superior to gradient-echo sequences in screening for multifocal, familial cavernous malformations.
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Affiliation(s)
- Kevin Y Wang
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA; Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oluwatoyin R Idowu
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris D M Lin
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Lee CC, Sheehan JP, Kano H, Akpinar B, Martinez-Alvarez R, Martinez-Moreno N, Guo WY, Lunsford LD, Liu KD. Gamma Knife radiosurgery for hemangioma of the cavernous sinus. J Neurosurg 2016; 126:1498-1505. [PMID: 27341049 DOI: 10.3171/2016.4.jns152097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Cavernous sinus hemangiomas (CSHs) are rare vascular tumors. A direct microsurgical approach usually results in massive hemorrhage and incomplete tumor resection. Although stereotactic radiosurgery (SRS) has emerged as a therapeutic alternative to microsurgery, outcome studies are few. Authors of the present study evaluated the role of SRS for CSH. METHODS An international multicenter study was conducted to review outcome data in 31 patients with CSH. Eleven patients had initial microsurgery before SRS, and the other 20 patients (64.5%) underwent Gamma Knife SRS as the primary management for their CSH. Median age at the time of radiosurgery was 47 years, and 77.4% of patients had cranial nerve dysfunction before SRS. Patients received a median tumor margin dose of 12.6 Gy (range 12-19 Gy) at a median isodose of 55%. RESULTS Tumor regression was confirmed by imaging in all 31 patients, and all patients had greater than 50% reduction in tumor volume at 6 months post-SRS. No patient had delayed tumor growth, new cranial neuropathy, visual function deterioration, adverse radiation effects, or hypopituitarism after SRS. Twenty-four patients had presented with cranial nerve disorders before SRS, and 6 (25%) of them had gradual improvement. Four (66.7%) of the 6 patients with orbital symptoms had symptomatic relief at the last follow-up. CONCLUSIONS Stereotactic radiosurgery was effective in reducing the volume of CSH and attaining long-term tumor control in all patients at a median of 40 months. The authors' experience suggests that SRS is a reasonable primary and adjuvant treatment modality for patients in whom a CSH is diagnosed.
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Affiliation(s)
- Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh, Pennsylvania; and
| | - Berkcan Akpinar
- Department of Neurosurgery, University of Pittsburgh, Pennsylvania; and
| | | | | | - Wan-Yuo Guo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - L Dade Lunsford
- Unit of Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Kang-Du Liu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Park CK, Choi SK, Kang IH, Choi MK, Park BJ, Lim YJ. Radiosurgical considerations for cavernous sinus hemangioma: long-term clinical outcomes. Acta Neurochir (Wien) 2016; 158:313-8. [PMID: 26658989 DOI: 10.1007/s00701-015-2657-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/30/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cavernous hemangiomas are rare vascular tumors in the cavernous sinus. Cranial neuropathies induced by cavernous sinus hemangiomas (CSH) necessitate tumor reduction, but surgery is extremely difficult due to the abundant vascularization of the lesion. We studied the effectiveness and safety of Gamma Knife radiosurgery (GKRS) for CSH. METHODS We performed a retrospective analysis of 25 patients with CSH who were treated by GKRS between March 1992 and December 2014. Age, sex, target volume, and irradiation dose were analyzed as prognostic factors for CSH treated by GKRS. RESULTS Eleven (84.6 %) patients had tumor shrinkage within 12 months after GKRS. Two patients experienced tumor progression, but tumor size decreased over 2 years after GKRS. No patients had permanent complications, and all patients experienced symptomatic improvement. There were no significant factors that predicted the prognosis of CSH. CONCLUSIONS The optimal treatment for CSH has been unclear; however, in this study, GKRS was an effective and safe treatment for CSH. Thus, GKRS may be a primary treatment for CSHs in high-risk surgery patients.
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Affiliation(s)
- Chang Kyu Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Il Ho Kang
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Man Kyu Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Bong Jin Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Young Jin Lim
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea.
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Stereotactic radiosurgery for cavernous sinus hemangiomas. J Neurooncol 2014; 118:163-8. [DOI: 10.1007/s11060-014-1414-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
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Bansal S, Suri A, Singh M, Kale SS, Agarwal D, Sharma MS, Mahapatra AK, Sharma BS. Cavernous sinus hemangioma: a fourteen year single institution experience. J Clin Neurosci 2013; 21:968-74. [PMID: 24524951 DOI: 10.1016/j.jocn.2013.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 09/04/2013] [Accepted: 09/12/2013] [Indexed: 12/23/2022]
Abstract
Cavernous sinus hemangioma (CSH) is a rare extra-axial vascular neoplasm that accounts for 2% to 3% of all cavernous sinus tumors. Their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures are factors which present difficulty in excising these lesions. The authors describe their experience of 22 patients with CSH over 14 years at a tertiary care center. Patients were managed with microsurgical resection using a purely extradural transcavernous approach (13 patients) and with Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) (nine patients). Retrospective data analysis found headache and visual impairment were the most common presenting complaints, followed by facial hypesthesia and diplopia. All but one patient had complete tumor excision in the surgical series. Transient ophthalmoparesis (complete resolution in 6-8 weeks) was the most common surgical complication. In the GKRS group, marked tumor shrinkage (>50% tumor volume reduction) was achieved in two patients, slight shrinkage in five and no change in two patients, with symptom improvement in the majority of patients. To our knowledge, we describe one of the largest series of CSH managed at a single center. Although microsurgical resection using an extradural transcavernous approach is considered the treatment of choice in CSH and allows complete excision with minimal mortality and long-term morbidity, GKRS is an additional tool for treating residual symptomatic lesions or in patients with associated comorbidities making surgical resection unsuitable.
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Affiliation(s)
- Sumit Bansal
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashish Suri
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Manmohan Singh
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Agarwal
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manish Singh Sharma
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashok Kumar Mahapatra
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhawani Shankar Sharma
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India
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9
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Stereotactic fractionated radiotherapy for cavernous venous malformations (hemangioma) of the orbit. Ophthalmic Plast Reconstr Surg 2012; 28:192-5. [PMID: 22581082 DOI: 10.1097/iop.0b013e31824a48f3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cavernous malformations (hemangioma) of the orbit, when symptomatic, can often be treated successfully with complete surgical excision. However, when they involve local structures in their capsule, are situated in the orbital apex, or extend through the superior orbital fissure, the risks of surgery increase significantly. In such cases, alternative treatment modalities can be explored. In this study, the authors report on the use of fractionated stereotactic radiotherapy (SFRT) for the treatment of surgically complicated cavernous malformations. METHODS In this retrospective cohort study, the authors reviewed the clinical and radiologic records of 5 patients treated with SFRT over the past 5 years. RESULTS Patients ranged in age from 30 to 65 years, and 3 out of 5 were female. Two cases involved the cavernous sinus, one involved the ophthalmic artery, one involved the posterior ciliary artery, and the last traversed the superior orbital fissure. Four had significant visual field defects. Each was treated with SFRT. A total dose of 4000 cGy divided into 20,200 cGy fractions was applied for 3 cases, while 2 other cases were treated with total doses of 4563 and 4959 cGy divided into 28 × 162 cGy and 29 × 171 cGy fractions, respectively. Rapid resolution of visual field defect was noted by 3 months, and overall tumor shrinkage was on average 60% (range: 32-79%). Follow-up was on average 23.4 months (range: 5-50 months). No complications of treatment were noted. CONCLUSIONS For symptomatic cavernous malformations demonstrating anatomical position that may increase risk of surgical excision, SFRT is an effective and safe method to control lesion size and improve visual function.
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The role of stereotactic radiosurgery in cavernous sinus hemangiomas: a systematic review and meta-analysis. J Neurooncol 2011; 107:239-45. [DOI: 10.1007/s11060-011-0753-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
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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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Spontaneous bleeding into a suprasellar cavernous angioma of a neonate: case report and literature review. Childs Nerv Syst 2011; 27:303-11. [PMID: 20419304 DOI: 10.1007/s00381-010-1161-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cavernous angiomas (CA) are congenital intraparenchymal vascular malformations that contain sinusoidal spaces lined by a single-layer endothelium, separated by collagenous stroma with no intervening brain parenchyma. Despite the congenital origin of CA, they rarely present in the neonatal and prenatal period. In this paper, we present a case report of a neonatal suprasellar CA that presented with a bleed. We also present a literature review focusing on specific features of intracranial CA in the neonatal and fetal age groups. CASE REPORT A 27-day-old neonate presented with a left eye ptosis for 2 days, followed by a generalized seizure. A head computed tomography revealed a suprasellar hematoma with intraventricular and subarachnoid extension. Brain magnetic resonance imaging revealed hemorrhages of various ages. Magnetic resonance angiography did not reveal any vascular malformation. Surgical exploration of the suprasellar mass revealed a capsulated dense hematoma. Postoperatively, the neonate was weaned of artificial ventilation over a protracted period and remained hemiparetic with signs of third nerve palsy. Pathology revealed a CA. CA presenting as a suprasellar bleed with subarachnoid and intraventricular extension is very rare especially among neonates. To the best of our knowledge, 20 cases of CA have been reported in the neonatal and fetal period in the English literature. Neonatal CA in general and suprasellar location in particular are extremely rare lesions. Neonatal/fetal CA seems to present more aggressively and have a worse prognosis compared to those presenting at a later age.
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Khan AA, Niranjan A, Kano H, Kondziolka D, Flickinger JC, Lunsford LD. STEREOTACTIC RADIOSURGERY FOR CAVERNOUS SINUS OR ORBITAL HEMANGIOMAS. Neurosurgery 2009; 65:914-8; discussion 918. [DOI: 10.1227/01.neu.0000356987.98197.71] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
Hemangiomas are rare but highly vascular tumors that may develop in the cavernous sinus or orbit. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We analyzed our increasing experience using stereotactic radiosurgery (SRS).
METHODS
Eight symptomatic patients with hemangiomas underwent SRS between 1988 and 2007. The presenting symptoms included headache, orbital pain, diplopia, ptosis, proptosis and impaired visual acuity. The hemangiomas were located in either the cavernous sinus (7 patients) or the orbit (1 patient). Four patients underwent SRS as primary treatment modality based on clinical and imaging criteria. Four patients had previous microsurgical partial excision or biopsy. The median target volume was 6.8 mL (range, 2.5–18 mL). The median prescription dose delivered to the margin was 14.5 Gy (range, 12.5–19 Gy). The dose to the optic nerve in all patients was less than 9 Gy (range, 4.5–9 Gy).
RESULTS
The median follow-up period after SRS was 80 months (range, 40–127 months). Six patients had symptomatic improvement; 2 patients reported persistent diplopia. Follow-up imaging revealed tumor regression in 7 patients and no change in tumor volume in 1 patient. All the patients improved after SRS.
CONCLUSION
Our extended experience confirms that SRS is an effective management strategy for symptomatic intracavernous and intraorbital hemangiomas. Our study is the first long-term report on the safety and efficacy of SRS.
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Affiliation(s)
- Aftab A. Khan
- Department of Neurological Surgery, University of Pittsburgh, The Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh, The Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, The Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas Kondziolka
- Department of Neurological Surgery, University of Pittsburgh, The Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John C. Flickinger
- Department of Neurological Surgery, University of Pittsburgh, The Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L. Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, The Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Kon T, Mori H, Hasegawa K, Nishiyama K, Tanaka R, Takahashi H. Neonatal cavernous angioma located in the basal ganglia with profuse intraoperative bleeding. Childs Nerv Syst 2007; 23:449-53. [PMID: 17103006 DOI: 10.1007/s00381-006-0231-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 06/06/2006] [Indexed: 10/23/2022]
Abstract
CASE REPORT A rare case of congenital cavernous angioma detected during pregnancy is described. The tumor was pointed out by ultrasound in a fetus at 39 weeks gestation. The male baby was delivered by cesarean section. Computed tomography and magnetic resonance imaging revealed a tumor in the left basal ganglia. Because the tumor gradually enlarged and right hemiparesis became evident, a decision was made to remove the tumor. Because of profuse intraoperative bleeding, surgical total removal was not accomplished. Histopathological specimens revealed cavernous angioma. The patient was treated postoperatively with 30.4 Gy of local irradiation. His right hemiparesis improved and the tumor gradually decreased in size. DISCUSSION The literatures are reviewed and discussed about clinical features and management controversies of this rare tumor.
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Affiliation(s)
- T Kon
- Department of Neurosurgery, Brain Research Institute, Niigata University, Asahimachi, Niigata, Japan.
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Boockvar JA, Stiefel M, Malhotra N, Dolinskas C, Dwyer-Joyce C, LeRoux PD. Dural cavernous angioma of the posterior sagittal sinus: case report. ACTA ACUST UNITED AC 2005; 63:178-81; discussion 181. [PMID: 15680668 DOI: 10.1016/j.surneu.2004.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 03/10/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Extraaxial cavernous hemangiomas (cavernomas) are very rare lesions, and less than 20 descriptions of these lesions outside the middle fossa have been reported. In this report, we describe a dural cavernous angioma involving the posterior sagittal sinus and discuss the clinical, radiological, operative, and histological features of this very uncommon lesion. CASE DESCRIPTION A 31-year-old right-handed male presented with headache and decreasing visual acuity. Severe bilateral papilledema was found on fundoscopic examination. Neurological examination demonstrated a minor right temporal field cut. Brain magnetic resonance imaging with contrast demonstrated a 2.5 x 2.5 cm hyperintense enhancing mass in the midline, which was contiguous with the posterior margin of the falx cerebri. The patient underwent a bilateral occipital craniotomy centered on the lesion. The histological features were consistent with cavernous angioma. CONCLUSION This report demonstrates that although extra axial cavernomas are quite rare, they must be included in the differential diagnosis of enhancing lesions along the posterior sagittal sinus. The operative removal of these lesions can be quite treacherous and usually requires a careful reapproximation of the patent sinus after lesion excision.
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Nakamura N, Shin M, Tago M, Terahara A, Kurita H, Nakagawa K, Ohtomo K. Gamma knife radiosurgery for cavernous hemangiomas in the cavernous sinus. J Neurosurg 2002. [DOI: 10.3171/jns.2002.97.supplement_5.0477] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ A cavernous hemangioma occurring in the cavernous sinus is a rare vascular tumor that causes cranial nerve symptoms by direct compression. Surgical removal is often difficult because excessive intraoperative bleeding is expected. These lesions remain a therapeutic challenge even with state-of-the-art treatment modalities. The authors report three cases of cavernous hemangioma occurring in the cavernous sinus that were treated with gamma knife radiosurgery, with a mean patient age of 66 years and a mean tumor volume of 2.3 cm3.
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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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Hashimoto M, Yokota A, Ohta H, Urasaki E. Intratumoral injection of plastic adhesive material for removal of cavernous sinus hemangioma. Technical note. J Neurosurg 2000; 93:1078-81. [PMID: 11117855 DOI: 10.3171/jns.2000.93.6.1078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case in which a cavernous sinus (CS) hemangioma was totally removed following intratumoral injection of a plastic fixation material. This unique method is extremely useful for the removal of CS hemangiomas, which often feature massive intraoperative bleeding as an unsolved problem.
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Affiliation(s)
- M Hashimoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Seo Y, Fukuoka S, Sasaki T, Takanashi M, Hojo A, Nakamura H. Cavernous sinus hemangioma treated with gamma knife radiosurgery: usefulness of SPECT for diagnosis--case report. Neurol Med Chir (Tokyo) 2000; 40:575-80. [PMID: 11109795 DOI: 10.2176/nmc.40.575] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 79-year-old female presented with cavernous sinus hemangioma manifesting as double vision due to right oculomotor and trochlear nerve pareses. Computed tomography and magnetic resonance imaging revealed bony erosion and a right cavernous sinus tumor with "tail sign" after contrast medium administration. Thallium-201 (201Tl) single photon emission computed tomography (SPECT) showed low uptake within the tumor, and technetium-99m-human serum albumin-diethylenetriaminepenta-acetic acid SPECT disclosed high uptake within the tumor. 201Tl SPECT usually shows very high uptake in meningiomas and malignant tumors, so the tumor was considered to be an unrelated benign tumor. The patient underwent partial resection of the tumor. Histological examination of the specimen confirmed cavernous hemangioma. The oculomotor nerve paresis partially improved. Gamma knife radiosurgery was carried out 4 months after the operation. The tumor markedly shrank with full recovery of extraocular movement 6 months after radiosurgery. SPECT is useful for distinguishing cavernous sinus hemangiomas from other cavernous tumors. Radiosurgery should be performed after partial resection or biopsy for cavernous sinus hemangiomas and may be the initial treatment for patients with small cavernous sinus hemangioma if the diagnosis can be established based on neuroimaging.
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MESH Headings
- Aged
- Brain Neoplasms/diagnostic imaging
- Brain Neoplasms/pathology
- Brain Neoplasms/surgery
- Decompression, Surgical
- Diagnosis, Differential
- Female
- Hemangioma, Cavernous, Central Nervous System/diagnostic imaging
- Hemangioma, Cavernous, Central Nervous System/pathology
- Hemangioma, Cavernous, Central Nervous System/surgery
- Humans
- Magnetic Resonance Imaging
- Radiosurgery/methods
- Technetium Tc 99m Aggregated Albumin
- Technetium Tc 99m Pentetate
- Tomography, Emission-Computed, Single-Photon/methods
- Treatment Outcome
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Affiliation(s)
- Y Seo
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
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Ohata K, El-Naggar A, Takami T, Morino M, El-Adawy Y, El-Sheik K, Inoue Y, Hakuba A. Efficacy of induced hypotension in the surgical treatment of large cavernous sinus cavernomas. J Neurosurg 1999; 90:702-8. [PMID: 10193616 DOI: 10.3171/jns.1999.90.4.0702] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cavernous sinus cavernomas are rare lesions associated with high rates of intraoperative mortality and morbidity resulting from profuse bleeding. In this paper, the authors report their experience in treating five patients with histologically confirmed cavernous sinus cavernomas and describe the efficacy of induced hypotension in facilitating excision of the lesion. METHODS All five patients were women ranging in age from 25 to 54 years, with an average age of 42 years. The mass was small in one and large (>3 cm in diameter) in four. In one patient with a large mass, cardiac arrest occurred after the craniotomy, and remarkable reduction in the size of the cavernoma was evident on postmortem examination. The other three large lesions were successfully removed piecemeal after induction of hypotension (60-80 mm Hg systolic pressure), which remarkably reduced the mass and the bleeding during surgery. In the remaining patient, who had a small lesion, the cavernoma was removed in one piece. CONCLUSIONS Cavernous sinus cavernoma can be thought of as a cluster of sinusoidal cavities, the size of which varies depending on the systemic blood pressure. During surgery, reduction of the mass and control of bleeding from the cavernoma can be achieved by inducing hypotension, which enables the safe excision of this lesion. This technique should be considered by surgeons resecting a cavernous sinus tumor, especially when cavernoma is suspected.
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Affiliation(s)
- K Ohata
- Department of Neurosurgery, Osaka City University Medical School, Osaka, Japan
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Suzuki Y, Shibuya M, Baskaya MK, Takakura S, Yamamoto M, Saito K, Glazier SS, Sugita K. Extracerebral cavernous angiomas of the cavernous sinus in the middle fossa. SURGICAL NEUROLOGY 1996; 45:123-32. [PMID: 8607061 DOI: 10.1016/s0090-3019(96)80004-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Intracranial extracerebral cavernous angiomas (ECCAs) share the same histologic features as intracerebral lesions, but their clinical picture is different. Surgical treatment of ECCAs of the cavernous sinus remains a challenge for the neurosurgeon because of a high mortality and morbidity due to uncontrollable and massive hemorrhage. METHODS We have experienced seven patients with ECCAs of the cavernous sinus between 1982 and 1994. All cases were verified histologically during surgery and two were totally resected during the first surgical attempt. Six of seven patients were female. The mean age at diagnosis was 54.5 years (range; 43 to 71 years). RESULTS Computed tomography showed a round or dumbbell-shaped mass in the area of the cavernous sinus. Magnetic resonance imaging revealed a low to isointense mass lesion on the T1-weighted image. Only one of our patients showed a minimal amount of vascular staining on angiography. The total excision of these malformations was difficult because intraoperative bleeding could be profuse. In one case, radiation therapy induced a reduction in the size of the tumor after failure of surgical removal. CONCLUSIONS In planning surgical strategy for ECCAs, care should be taken to control the massive bleeding. Radiation therapy is helpful to suppress the tumor growth.
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Affiliation(s)
- Y Suzuki
- Department of Neurosurgery, Nagoya University School of Medicine, Japan
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