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Han G, Huang Z, Qiao H, Zhu W, Yan X, Pu K, Li Q, Tong X. Diagnostic value of cavernous sinus swelling and extrusion sign in cavernous sinus hemangioma. Heliyon 2024; 10:e26201. [PMID: 38434011 PMCID: PMC10906154 DOI: 10.1016/j.heliyon.2024.e26201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND AND PURPOSE To examine the diagnostic value of imaging features in cavernous sinus hemangioma (CSH). MATERIALS AND METHODS The clinical and imaging data of patients with pathologically confirmed CSH, cavernous sinus meningioma, trigeminal schwannoma and pituitary adenoma invading the cavernous sinus between May 2017 and May 2022 were retrospectively analyzed. The cases were divided into the CSH and non-CSH groups to summarize the magnetic resonance imaging (MRI) characteristics of CSH. Univariate χ2 analysis was performed to assess five indexes, including signal intensity on T2WI, homogeneity of T2WI, enhancement of enhanced T1, enhanced T1 with dural tail sign, and cavernous sinus swelling and extrusion sign. RESULTS There were significant differences in four features, including hyperintensity on T2WI, homogeneity of T2WI, T1-enhanced without meningeal tail sign, and cavernous sinus swelling and extrusion sign between the CSH and non-CSH groups, with cavernous sinus swelling and extrusion sign showing the most pronounced distinction, with a sensitivity of 100%, a specificity of 93.02%, and an accuracy of 94.23%. The four features could be jointly used as diagnostic criteria, with a sensitivity of 94.44%, a specificity of 100.00%, and an accuracy of 99.04%. CONCLUSION Cavernous sinus swelling and extrusion sign is a reliable imaging index for CSH diagnosis. Homogenous hyperintensity or marked hyperintensity on T2WI, enhanced T1 without dural tail sign, and cavernous sinus swelling and extrusion sign could be jointly used as diagnostic criteria, which may improve the accuracy of CSH diagnosis.
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Affiliation(s)
- Guoqing Han
- Departments of Neurosurgery, Tianjin University Huanhu Hospital, Tianjin, China
| | - Zhifa Huang
- Departments of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Huanhuan Qiao
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Wei Zhu
- Departments of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Xuejiang Yan
- Departments of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Ke Pu
- Departments of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Qingguo Li
- Departments of Neurosurgery, Tianjin University Huanhu Hospital, Tianjin, China
| | - Xiaoguang Tong
- Departments of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
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2
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Kuroedov D, Cunha B, Pamplona J, Castillo M, Ramalho J. Cerebral cavernous malformations: Typical and atypical imaging characteristics. J Neuroimaging 2023; 33:202-217. [PMID: 36456168 DOI: 10.1111/jon.13072] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022] Open
Abstract
Cavernous malformations (CMs) are benign vascular malformations that maybe seen anywhere in the central nervous system. They are dynamic lesions, growing or shrinking over time and only rarely remaining stable. Size varies from a few millimeters to a few centimeters. CMs can be sporadic or familial, and while most of them are congenital, de novo and acquired lesions may also be seen. Etiology is still unknown. A genetic molecular mechanism has been proposed since a cerebral cavernous malformation gene loss of function was found in both familial and sporadic lesions. Additionally, recent studies suggest that formation of CMs in humans may be associated with a distinctive bacterial gut composition (microbioma). Imaging is fairly typical but may vary according to age, location, and etiology. Follow-up is not well established because CMs patients have a highly unpredictable clinical course. Angiogenic and inflammatory mechanisms have been implicated in disease activity, as well as lesional hyperpermeability and iron deposition. Imaging and serum biomarkers of these mechanisms are under current investigation. Treatment options, including surgery or radiosurgery, are not well defined and are dependent upon multiple factors, including clinical presentation, lesion location, number of hemorrhagic events, and medical comorbidities. Our purpose is to review the imaging features of CMs based on their size, location, and etiology, as well as their differential diagnosis and best imaging approach. New insights in etiology will be briefly considered. Follow-up strategies, including serum and imaging biomarkers, and treatment options will also be discussed.
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Affiliation(s)
- Danila Kuroedov
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Bruno Cunha
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jaime Pamplona
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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3
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Mishra SC, Chaturvedi P, Gupta A, Sharma S. Cavernous haemangioma of cavernous sinus causing diagnostic dilemma: a case report with review of literature. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cavernous haemangioma of the cavernous sinus is an uncommon vascular malformation. It is often confused with other parasellar masses like schwannomas and meningiomas due to overlap in imaging appearance. It is important to pre-operatively diagnose this condition as it is associated with severe intra-operative bleeding.
Case presentation
Here, we report a case of an octogenarian female who presented with left sided progressive ptosis and diminution of vision for one year. Cross-sectional imaging includes computed tomography and magnetic resonance imaging which were not conclusive of cavernous sinus haemangioma. Digital subtraction angiography was done which showed a vascular blush. After corroborating the findings of these imaging investigations, a diagnosis of cavernous sinus haemangioma was concluded. Patient underwent surgery which showed a hypervascular mass. Histopathology was consistent with the imaging diagnosis. Patient was discharged in good stable condition and doing well and is on follow-up in Neurosurgery Out-Patient Department.
Conclusions
The cavernous sinus Haemangiomas are uncommon benign vascular masses. They pose a diagnostic challenge when seen in the parasellar region as the imaging findings of a haemangioma, meningioma and schwannoma in this location can have a significant overlap in the imaging findings. Cross-sectional imaging, digital subtraction angiography and nuclear imaging help in pre-operative diagnosis which is a crucial as the surgery is associated with significant blood loss.
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A radiomics-based study for differentiating parasellar cavernous hemangiomas from meningiomas. Sci Rep 2022; 12:15509. [PMID: 36109577 PMCID: PMC9478116 DOI: 10.1038/s41598-022-19770-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractTo investigate the value of the radiomic models for differentiating parasellar cavernous hemangiomas from meningiomas and to compare the classification performance with different MR sequences and classifiers. A total of 96 patients with parasellar tumors (40 cavernous hemangiomas and 56 meningiomas) were enrolled in this retrospective multiple-center study. Univariate and multivariate analyses were performed to identify the clinical factors and semantic features of MRI scans. Radiomics features were extracted from five MRI sequences using radiomics software. Three feature selection methods and six classifiers were evaluated in the training cohort to construct favorable radiomic machine-learning classifiers. The performance of different classifiers was evaluated using the AUC and compared to neuroradiologists. The detection rates of T1WI, T2WI, and CE-T1WI for parasellar cavernous hemangiomas and meningiomas were approximately 100%. In contrast, the ADC maps had the detection rate of 18/22 and 19/25, respectively, (AUC, 0.881) with 2.25 cm as the critical value diameter. Radiomics models with the SVM and KNN classifiers based on T2WI and ADC maps had favorable predictive performances (AUC > 0.90 and F-score value > 0.80). These models outperformed MRI model (AUC 0.805) and neuroradiologists (AUC, 0.756 and 0.545, respectively). Radiomic models based on T2WI and ADC and combined with SVM and KNN classifiers have the potential to be a viable method for differentiating parasellar hemangiomas from meningiomas. T2WI is more universally applicable than ADC values due to its higher detection rate for parasellar tumors.
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Lubomirsky B, Jenner ZB, Jude MB, Shahlaie K, Assadsangabi R, Ivanovic V. Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches. Neuroradiol J 2022; 35:269-283. [PMID: 34856828 PMCID: PMC9244752 DOI: 10.1177/19714009211055195] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.
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Affiliation(s)
- Bryan Lubomirsky
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Zachary B Jenner
- Department of Radiology, Diagnostic
and Interventional Radiology Residency, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Morgan B Jude
- School of Medicine, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Reza Assadsangabi
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
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Osunronbi T, May Myat Noe Pwint P, Usuah J, Cain J, Mathur S, Gurusinghe NT, Roberts GA, Alalade AF. Cavernous sinus haemangioma: systematic review and pooled analysis relating to a rare skull base pathology. Neurosurg Rev 2022; 45:2583-2592. [DOI: 10.1007/s10143-022-01796-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
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Benson J, Eschbacher K, Raghunathan A, Johnson D, Kim D, Van Gompel J. Cavernous Sinus Vascular Venous Malformation. AJNR Am J Neuroradiol 2022; 43:19-23. [PMID: 34764085 PMCID: PMC8757562 DOI: 10.3174/ajnr.a7343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/09/2021] [Indexed: 01/03/2023]
Abstract
Vascular venous malformations of the cavernous sinus have multiple imaging features that can be used to distinguish them from other entities in the region. Accurate identification of these lesions is essential: Vascular venous malformation lesions carry considerable risk of intraoperative hemorrhage, so preoperative recognition of vascular venous malformations can greatly impact the treatment strategies used. Nevertheless, because of their scarcity, many radiologists are unfamiliar with the radiologic and clinical features of cavernous sinus vascular venous malformations. This article will describe a case of an asymptomatic vascular venous malformation; outline its imaging, clinical, and pathologic features; and review the relevant literature regarding this diagnosis.
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Affiliation(s)
- J.C. Benson
- From the Departments of Radiology (J.C.B., D.J., D.K.K.)
| | | | | | - D. Johnson
- From the Departments of Radiology (J.C.B., D.J., D.K.K.)
| | - D.K. Kim
- From the Departments of Radiology (J.C.B., D.J., D.K.K.)
| | - J. Van Gompel
- Neurologic Surgery (J.V.G.), Mayo Clinic, Rochester, Minnesota
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8
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Repeat gamma knife radiosurgery for cavernous sinus hemangiomas: A report of 3 cases. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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He J, Liu N, Liu W, Zhou W, Wang Q, Hu H. CT and MRI characteristic findings of sporadic renal hemangioblastoma: Two case reports. Medicine (Baltimore) 2021; 100:e24629. [PMID: 33578578 PMCID: PMC7886462 DOI: 10.1097/md.0000000000024629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hemangioblastomas in the kidney are rare. Although a few cases of renal hemangioblastoma (RH) have been reported, the content of these articles mainly focused on clinical and pathological research, with minimal descriptions of radiologic findings. Moreover, there are no descriptions of magnetic resonance imaging (MRI) with enhancement of this condition. Herein, we report 2 cases of RH with computed tomography (CT) and MRI findings. PATIENT CONCERNS Two patients presented to our institution because of dull pain in the left abdomen, and a mass in the left kidney was found by ultrasound examination in each case. The patient had no special family history. Physical examination revealed no obvious tenderness or percussion pain in the renal and ureteral walking areas, and there was no obvious mass. Routine blood and urine tests were normal, and the serum tumor markers were negative. No obvious lesions were found on imaging of the other body parts. DIAGNOSIS Similar radiologic findings were observed in both cases and mimicked those of cavernous hemangiomas of the liver, including peripheral nodular enhancement in the corticomedullary phase, progressive centripetal enhancement in the nephrographic and delayed phases, and occasional complete "filling in" in the delayed phase. We made a radiologic diagnosis of renal clear cell carcinoma for patient 1 and suspected renal clear cell carcinoma for patient 2, but the pathological results showed RH. INTERVENTIONS Given the suspicion of renal cell carcinoma, both patients underwent partial nephrectomy. OUTCOME The recovery of the two patients was uneventful, and there was no evidence of local recurrence or metastasis many years after surgery. LESSONS RH is a rare benign tumor that can be easily misdiagnosed as clear cell carcinoma. Characteristic CT and MRI manifestations may improve preoperative diagnostic accuracy to avoid surgery or indicate nephron-sparing surgery.
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Affiliation(s)
| | - Nan Liu
- Department of Critical Care Medicine
| | - Wangwang Liu
- Department of Pathology, Sir Run Run Shaw Hospital
| | | | - Qiangfeng Wang
- Department of Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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10
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Montoya F, Vidal A, Sepulveda F, Marileo R, Caro J, Castillo M. Cavernous Sinus Hemangioma: Imaging Diagnosis and Surgical Considerations. World Neurosurg 2020; 146:e30-e37. [PMID: 33031964 DOI: 10.1016/j.wneu.2020.09.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cavernous sinus hemangiomas (CSHs) are extraaxial vascular malformations that tend to bleed during surgery. METHODS We reviewed 12 magnetic resonance imaging scans with CSH, 5 of them biopsy proven. RESULTS In our review, CSH commonly presented as a lobulated mass with high, uniform signal intensity on T2-weighted images, a dumbbell shape, and a sellar extension. Two thirds presented a "filling-in" pattern of enhancement on dynamic imaging. These features should lead to a correct preoperative diagnosis, which is essential for surgical planning and avoiding hemorrhagic complications. CONCLUSIONS A combination of low signal on T1, high signal on T2 and fluid-attenuated inversion recovery, no diffusion restriction and homogenous enhancement should place CSH at the top of the list of differential diagnoses. This is especially true when there is a "filling-in" pattern on dynamic or delayed imaging. Doing so may alert surgeons to the possibility of copious intraoperative bleeding and therefore avoid complications of hemorrhage.
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Affiliation(s)
- Francisca Montoya
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile.
| | - Aaron Vidal
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Francisco Sepulveda
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Roberto Marileo
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Joseline Caro
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
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11
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Bi S, Chen R, Zhang K, Xiang Y, Wang R, Lin H, Yang H. Differentiate cavernous hemangioma from schwannoma with artificial intelligence (AI). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:710. [PMID: 32617330 PMCID: PMC7327353 DOI: 10.21037/atm.2020.03.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Cavernous hemangioma and schwannoma are tumors that both occur in the orbit. Because the treatment strategies of these two tumors are different, it is necessary to distinguish them at treatment initiation. Magnetic resonance imaging (MRI) is typically used to differentiate these two tumor types; however, they present similar features in MRI images which increases the difficulty of differential diagnosis. This study aims to devise and develop an artificial intelligence framework to improve the accuracy of clinicians' diagnoses and enable more effective treatment decisions by automatically distinguishing cavernous hemangioma from schwannoma. Methods Material: As the study materials, we chose MRI images as the study materials that represented patients from diverse areas in China who had been referred to our center from more than 45 different hospitals. All images were initially acquired on films, which we scanned into digital versions and recut. Finally, 11,489 images of cavernous hemangioma (from 33 different hospitals) and 3,478 images of schwannoma (from 16 different hospitals) were collected. Labeling: All images were labeled using standard anatomical knowledge and pathological diagnosis. Training: Three types of models were trained in sequence (a total of 96 models), with each model including a specific improvement. The first two model groups were eye- and tumor-positioning models designed to reduce the identification scope, while the third model group consisted of classification models trained to make the final diagnosis. Results First, internal four-fold cross-validation processes were conducted for all the models. During the validation of the first group, the 32 eye-positioning models were able to localize the position of the eyes with an average precision of 100%. In the second group, the 28 tumor-positioning models were able to reach an average precision above 90%. Subsequently, using the third group, the accuracy of all 32 tumor classification models reached nearly 90%. Next, external validation processes of 32 tumor classification models were conducted. The results showed that the accuracy of the transverse T1-weighted contrast-enhanced sequence reached 91.13%; the accuracy of the remaining models was significantly lower compared with the ground truth. Conclusions The findings of this retrospective study show that an artificial intelligence framework can achieve high accuracy, sensitivity, and specificity in automated differential diagnosis between cavernous hemangioma and schwannoma in a real-world setting, which can help doctors determine appropriate treatments.
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Affiliation(s)
- Shaowei Bi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,School of Computer Science and Technology, Xidian University, Xi'an, China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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12
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Munawar K, Nayak G, Fatterpekar GM, Sen C, Zagzag D, Zan E, Hagiwara M. Cavernous sinus lesions. Clin Imaging 2020; 68:71-89. [PMID: 32574933 DOI: 10.1016/j.clinimag.2020.06.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Infectious and inflammatory diseases include Tolosa-Hunt syndrome, sarcoidosis, granulomatosis with polyangiitis, IgG-4 related disease and invasive fungal infections. In this article, we review the clinical and imaging findings of a number of pathologies involving the cavernous sinus, focusing on key features that can narrow the differential diagnosis and, in some cases, support a particular diagnosis.
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Affiliation(s)
- Kamran Munawar
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Gopi Nayak
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Girish M Fatterpekar
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Chandra Sen
- NYU Langone Health, Department of Neurosurgery, New York, NY, United States of America
| | - David Zagzag
- NYU Langone Health, Department of Pathology, New York, NY, United States of America
| | - Elcin Zan
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Mari Hagiwara
- NYU Langone Health, Department of Radiology, New York, NY, United States of America.
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13
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Ibrahim D, El Fiki A, Hafez M, Saleem S. Report of a case of cavernous haemangioma of the cavernous sinus. BJR Case Rep 2020; 5:20190031. [PMID: 31938563 PMCID: PMC6945263 DOI: 10.1259/bjrcr.20190031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/05/2022] Open
Abstract
Cavernous haemangioma of the cavernous sinus is a rare vascular malformation. It's often confused with other parasellar masses. Here, we report a case of a female with a left parasellar mass which was misdiagnosed as schwannoma vs meningioma using CT and MRI. The patient was operated via the pterional approach but resection had been halted due to severe haemorrhage and only tumour biopsy could be obtained. The diagnosis of cavernous sinus haemangioma was established by histopathology and confirmed by subsequent digital subtraction angiography. The patient refused second surgery or adjuvant radiosurgery and the treatment strategy was observation and follow-up. Retrospectively, we included the key radiographic features of cavernous sinus haemangioma which would facilitate pre-operative diagnosis and avoid unforeseen operative complications. Diagnostic radiographic features include a well-defined mass in the cavernous sinus which shows isodense to slightly hyperdense attenuation on non-contrast CT scan with possible adjacent pressure bone remodelling. On MRI, it shows remarkable high T2 signal; intense homogenous enhancement or characteristic progressive contrast enhancement on sequential enhanced images. On digital subtraction angiography, it may demonstrate a vascular blush.
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Affiliation(s)
- Dalia Ibrahim
- Department of Radiology, Lecturer of Radiodiagnosis, Kasr Al Ainy Hospital, Egypt
| | - Ahmed El Fiki
- Department of Neurosurgery, Assistant professor of Neurosurgery, Kasr Al Ainy Hospital, Egypt
| | - Mohamed Hafez
- Professor and head of Neurosurgery department, Kasr Al Ainy Hospital, Egypt
| | - Sahar Saleem
- Department of Radiology, Professor of Radiodiagnosis, Kasr Al Ainy Hospital, Egypt
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14
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Lan Z, Richard SA, Li J, Xu J, You C. A giant solid cavernous hemangioma mimicking sphenoid wing meningioma in an adolescent: A case report. Medicine (Baltimore) 2018; 97:e13098. [PMID: 30383694 PMCID: PMC6221700 DOI: 10.1097/md.0000000000013098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Central nervous system (CNS) solid cavernous hemangiomas are rare extra-axial anomalies that may sometimes resemble meningiomas. Due to their complex vascular nature, accurate preoperative diagnosis is important to avoid disastrous hemorrhage during operation. To the best of our knowledge this is the first case in an adolescent since all middle cranial fossa hemangioma cases reported in literature are adults in their 40s or 50s and all the pediatric cases are cystic. PATIENT CONCERNS We present a case of a 14-year-old girl with headache and dizziness for 3 months. She occasionally experienced nausea and vomiting but denied visual disturbances and loss of smell. DIAGNOSES MRI revealed a lesion that extends to the greater wing of the sphenoid bone as well as the pituitary fossa. Our initial diagnosis was a sphenoid wing meningioma but interestingly, histopathology revealed solid cavernous hemangioma. INTERVENTIONS The residual tumor was completely removed with 2 sessions of Gamma Knife radiotherapy after surgery. OUTCOMES We were confronted with excessive bleeding during surgery so we attained subtotal resection. However, the patient recovered well with no recurrence of the tumor. LESSONS Our case shows that space occupying lesions involving the cavernous sinus and sphenoid ridged could be easily misdiagnosed as sphenoid wing meningiomas in children and adolescents and even adults therefore great care must be exercised when confronted with this kind of presentation.
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Affiliation(s)
- Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
- Department of Surgery, Volta Regional Hospital, Ghana, West Africa
| | - Jin Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan PR China
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Lee CC, Trifiletti DM, Sahgal A, DeSalles A, Fariselli L, Hayashi M, Levivier M, Ma L, Álvarez RM, Paddick I, Regis J, Ryu S, Slotman B, Sheehan J. Stereotactic Radiosurgery for Benign (World Health Organization Grade I) Cavernous Sinus Meningiomas—International Stereotactic Radiosurgery Society (ISRS) Practice Guideline: A Systematic Review. Neurosurgery 2018; 83:1128-1142. [DOI: 10.1093/neuros/nyy009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/05/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio DeSalles
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Laura Fariselli
- Radiotherapy unit, Radiosurgery dep Istituto neurologico Carlo Besta Foundation, Milan, Italy
| | - Motohiro Hayashi
- Department of Neurosurgery, Tokyo Women's Medical University, Toyko, Japan
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- Division Physics, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Roberto Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Ian Paddick
- Division Physics, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jean Regis
- Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University, Stony Brook, New York
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
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16
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Bakhsheshian J, Zada G, Pham MH. Cavernous Sinus Hemangioma: Rare Vascular Tumor of Cavernous Sinus. World Neurosurg 2017; 110:432-433. [PMID: 29229344 DOI: 10.1016/j.wneu.2017.11.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Abstract
Cavernous sinus hemangiomas (CSHs) are rare vascular tumors, which are infrequently encountered in everyday neurosurgical practice. Attempted resection of this lesion without preoperative planning carries a high risk for significant blood loss and cranial neuropathies. Radiation treatments can provide an alternative and safe treatment modality for these lesions. Therefore an increased awareness is warranted for their clinical suspicion. We reported on a patient who presented with visual deficits and a mass in the sellar, suprasellar, and middle fossa regions. Given the high suspicion for a CSH due to characteristic radiologic findings, a keyhole craniotomy approach was safely used for an open biopsy. The final pathology was consistent with a CSH, and the patient subsequently underwent radiation therapy without complications.
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Affiliation(s)
- Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Martin H Pham
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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17
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Mahajan A, Rao VRK, Anantaram G, Polnaya AM, Desai S, Desai P, Vadapalli R, Panigrahi M. Clinical-radiological-pathological correlation of cavernous sinus hemangioma: Incremental value of diffusion-weighted imaging. World J Radiol 2017; 9:330-338. [PMID: 28932362 PMCID: PMC5583528 DOI: 10.4329/wjr.v9.i8.330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/18/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To elucidate the clinical, magnetic resonance imaging (MRI), pathological features of these lesions and asses the incremental value of diffusion-weighted imaging (DWI) in diagnosing them.
METHODS Fifteen consecutive patients (11 females and 4 males; mean age 40.93 years; age range 13-63 years) with cavernous sinus hemangiomas (CSH) who underwent examination between November 2008 and May 2016 were included for the analysis. MRI, clinical and surgical findings of each patient was retrospectively reviewed. DWI were also analysed and mean-apparent diffusion coefficient (ADC) value was calculated. Eleven patients underwent surgical removal of the lesion and 2 patients had biopsy only. Diagnosis of CSH was confirmed histologically in 13 patients.
RESULTS Eleven patients (73%) presented with headaches and 10 (66%) had cranial nerve involvement. Extra cavernous sinus extension was noted in 14 (94%). Surgery was performed in 13 (87%) and post-operative radiation was given to 4 (28%) patients. Thirteen patients remained asymptomatic on follow up. Three conspicuous imaging features were highly suggestive of the diagnosis: Lack of diffusion restriction (100%), homogeneous hyperintensity on T2 weighted image sequences (93.3%) and intense post-contrast enhancement (100%). The mean ADC was 1.82 × 10-3 ± 0.2186 cm2/s.
CONCLUSION T1-weighted hypointensity with homogeneous hyperintensity on T2-weighted sequences, intense enhancement and absence of hemosiderin within the lesion on GRE sequence favour the diagnosis. Facilitated diffusion on DWI differentiates CSH from other solid cavernous sinus lesions and significantly improves the diagnostic accuracy, a critical factor for planning surgery.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai 400012, India
| | - Vedula Rajni Kanth Rao
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad 500003, India
| | - Gudipati Anantaram
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad 500003, India
| | - Ashwin M Polnaya
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai 400012, India
| | - Sandeep Desai
- Department of Radiodiagnosis Clumax Imaging, Bangalore 560011, India
| | - Paresh Desai
- Department of Radiology, Apollo Victor Hospital, Goa 403601, India
| | - Rammohan Vadapalli
- Department of Radiology, Vijaya Diagnostics, Hyderabad, Secunderabad 500003, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad 500003, India
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18
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Meincke J, Lützen N, Doostkam S, Urbach H. Teaching Neuroimages: "Filling out" in Cavernous Hemangioma of the Cavernous Sinus. Clin Neuroradiol 2017; 28:137-138. [PMID: 28721610 DOI: 10.1007/s00062-017-0607-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- J Meincke
- Dept. of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - N Lützen
- Dept. of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - S Doostkam
- Dept. of Neuropathology, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - H Urbach
- Dept. of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.
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19
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Naik S, Phadke RV, Taunk A, Singh V, Bhoi SK. Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Diagnosis of Cavernous Hemangioma of Cavernous Sinus. J Neurosci Rural Pract 2017; 8:311-313. [PMID: 28479824 PMCID: PMC5402516 DOI: 10.4103/0976-3147.203832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rajendra V Phadke
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arpit Taunk
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjeev Kumar Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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20
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MARTÍN-PÉREZ MÁ, MARÍN-BALBÍN JM, BLANCO-HERNÁNDEZ R, MARTÍN-GARCÍA I, TABERNERO-RICO R, GONZALO-DOMÍNGUEZ M. Resonancia magnética en hipoacusia y vértigo. REVISTA ORL 2017. [DOI: 10.14201/orl201781.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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21
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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: 29] [Impact Index Per Article: 4.1] [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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22
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23
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[Orbito-palpebral vascular pathology]. J Fr Ophtalmol 2016; 39:804-813. [PMID: 27769582 DOI: 10.1016/j.jfo.2016.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/25/2016] [Accepted: 07/24/2016] [Indexed: 11/23/2022]
Abstract
Orbito-palpebral vascular pathology represents 10% of all the diseases of this area. The lesion may be discovered during a brain CT scan or MRI, or because it causes clinical symptoms such as orbital mass, visual or oculomotor alteration, pain, proptosis, or acute bleeding due to a complication of the lesion (hemorrhage, thrombosis). We present these lesions using an anatomical, clinical, imaging and therapeutic approach. We distinguish four different entities. Vascular tumors have common imaging characteristics (hypersignal on T2 sequence, contrast enhancement, abnormal vascularization well depicted with ultrasound and Doppler, and possible bleeding). The main lesions are cavernous hemangiomas, the most frequent lesion of that type during adulthood; infantile hemangiomas, the most frequent vascular tumor in children; and more seldomly, hemangioperitcytomas. True vascular malformations are divided according to their flow. Low flow lesions are venous (orbital varix), capillarovenous or lymphatic (lymphangioma). High flow malformations, more rare, are either arteriovenous or arterial malformations (aneurisms). Complex malformations include both low and high flow elements. Lesions leading to modifications of the orbito-palpebral blood flow are mainly due to cavernous sinus abnormalities, either direct carotid-cavernous fistula affecting young adults after severe head trauma, or dural fistula, more insidious, found in older adults. The last section is devoted to congenital syndromic vascular malformations (Sturge-Weber, Rendu-Olser…). This classification allows for a better understanding of these pathologies and their specific imaging features.
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24
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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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25
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Surgical Cavernous Malformations and Venous Anomalies. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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26
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MR imaging of cavernous sinus lesions: Pictorial review. J Neuroradiol 2015; 42:305-19. [DOI: 10.1016/j.neurad.2015.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 11/21/2022]
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27
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Narvid J, Talbott JF, Glastonbury CM. The caverno-apical triangle: anatomic-pathological considerations and pictorial review. Clin Imaging 2015; 40:23-32. [PMID: 26481233 DOI: 10.1016/j.clinimag.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The caverno-apical triangle (CAT) is defined from the components that define its contours: the cavernous sinus and the orbital apex. A wide range of pathologies arise from the space between the cavernous sinus and the orbital apex. OBJECT To better define radiologically this critical anatomic landmark and establish an organized approach for image analysis to help generate focused differential diagnoses and accurately characterize lesions found on imaging. CONCLUSION We have identified common imaging characteristics of frequently encountered lesions and divided them into specific categories to facilitate creation of logical and focused differential diagnoses.
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Affiliation(s)
- Jared Narvid
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Jason F Talbott
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Christine M Glastonbury
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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28
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Mathur A, Jain N, Kesavadas C, Thomas B, Kapilamoorthy TR. Imaging of skull base pathologies: Role of advanced magnetic resonance imaging techniques. Neuroradiol J 2015; 28:426-37. [PMID: 26427895 DOI: 10.1177/1971400915609341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Imaging plays a vital role in evaluation of skull base pathologies as this region is not directly accessible for clinical evaluation. Computerized tomography (CT) and magnetic resonance imaging (MRI) have played complementary roles in the diagnosis of the various neoplastic and non-neoplastic lesions of the skull base. However, CT and conventional MRI may at times be insufficient to correctly pinpoint the accurate diagnosis. Advanced MRI techniques, though difficult to apply in the skull base region, in conjunction with CT and conventional MRI can however help in improving the diagnostic accuracy. This article aims to highlight the importance of advanced MRI techniques like diffusion-weighted imaging, susceptibility-weighted imaging, perfusion-weighted imaging, and MR spectroscopy in differentiation of various lesions involving the skull base.
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Affiliation(s)
| | | | - C Kesavadas
- SCTIMST Trivandrum, Thiruvanathapuram, India
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29
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Tang X, Wu H, Wang B, Zhang N, Dong Y, Ding J, Dai J, Yu T, Pan L. A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases. Acta Neurochir (Wien) 2015; 157:961-9; discussion 969. [PMID: 25862173 DOI: 10.1007/s00701-015-2417-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/26/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cavernous sinus hemangiomas (CaSHs) are rare vascular lesions in the cavernous sinus(CS). Gamma Knife radiosurgery (GKS) provides a treatment modality alternative to microsurgery. This study was conducted to describe a new classification of CaSHs based on their magnetic resonance (MR) imaging findings and determine the efficacy and safety of GKS in a large series of CaSH patients. METHODS From April 2007 to November 2012, 53 patients harboring CaSHs were treated using Leksell Gamma Knife model C (before April 2012) or Perfexion (from May 2012 ) at the Gamma Knife Center of Huashan Hospital. Of the 53 patients, 15 with definitive histopathologic diagnoses after surgery, 38 were diagnosed based on their MR imaging findings. There were 15 male and 38 female patients with a mean age of 52 (range, 25-76) years old. The characteristics of MR images of CaSHs were their extremely high homogeneous intensity on T2-weighted and FLAIR images: as bright as cerebrospinal fluid signal. According to the relationship between the carotid line and their location, CaSHs were classified into three types: the intrasellar, parasellar and mixed type. The mean volume of the tumors was 13.2 ± 8.2 cm(3) (range, 1-41 cm(3)). A mean marginal dose of 13.3 Gy (range, 8-15 Gy) was directed to the 49%-64% isodose line (mean 53%). RESULTS Of the 53 tumors, 6 (11%) were classified as intrasellar type. Eight (15%) were parasellar type and the other 39 cases(74%) mixed type. The mean radiological and clinical follow-up time of this study was 24 (range, 2-67 months) and 34 months (range, 2-73 months), respectively. The tumor control rate was 100%. The mean tumor volume reduction was 79.5% (range, 16.5%-100%) compared with the pre-GKS volume. Six months after GKS, MR imaging revealed an average of 60.2% tumor volume reduction (range, 16.5%-89.2%). Twenty-nine cases (55%) showed a >80% tumor volume decrease. Neurologically, only two of these patients showed clinical deterioration, and 33 patients demonstrated an obvious improvement in ocular or endocrine disorders. At last follow-up, there were no more complications related to GKS, and none of the tumors progressed. CONCLUSIONS Our study showed that GKS is a useful and safe therapeutic method for CaSHs as both a primary and adjuvant treatment. The new classification of CaSHs may help predict their clinical course during tumor development and treatment response after GKS. Further studies with long-term follow-up and larger numbers of cases are necessary to optimize the treatment conditions and verify the benefit of this treatment.
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Abstract
Cavernous sinus hemangiomas are relatively rare but have characteristic imaging features. We present a case of a large extra-axial middle cranial fossa mass arising from the cavernous sinus in a 51-year-old female, and we describe the unique features and complications of this intracranial tumor. With the proper pre-operative diagnosis, an appropriate plan can be created for these highly vascular lesions, minimizing the risks involved with surgery.
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31
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Anqi X, Zhang S, Jiahe X, Chao Y. Cavernous sinus cavernous hemangioma: imaging features and therapeutic effect of Gamma Knife radiosurgery. Clin Neurol Neurosurg 2014; 127:59-64. [PMID: 25459244 DOI: 10.1016/j.clineuro.2014.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/02/2014] [Accepted: 09/26/2014] [Indexed: 02/05/2023]
Abstract
OBJECT To investigate the imaging features of cavernous sinus cavernous hemangioma (CSCH) and evaluate the therapeutic effect of Gamma Knife radiosurgery (GKRS) in treatment of CSCH. METHODS AND MATERIALS Fifteen patients with CSCH treated by GKRS in our institute, including 6 males and 9 females, age range 20-77 years old, were analyzed retrospectively. Three of them were given craniotomies as the initial therapy. All cases had performed conventional and contrast-enhanced MRI and 5 patients underwent dynamic enhanced MRI preoperatively. In 6 cases, the multi-directional continuous data of axial, coronal and sagittal enhanced MRI were acquired. Three cases performed digital subtraction angiography (DSA) simultaneously. The diagnoses of lesions were determined mainly depending on typical imaging features. In 3 patients, the diagnoses of CSCH were confirmed histopathologically. The radiation dosimetry was done with a goal of conformal and selective coverage of the lesion with a 50% prescription isodose line. The mean marginal dose constituted 13.4 Gy (range 10-16 Gy). After GKRS was performed, all patients were arranged regular clinical and MRI follow-up every 6 months during the first 12 months, and once per year thereafter. RESULTS On MRI, the lesions were typically demonstrated as iso/hypo-intensities on T1WI and remarkable hyper-intensities on T2WI, and apparent homogeneous enhancement. The phenomenon of dynamic enhancement was found in 11 cases. The progressive enhancing process from heterogeneous to uniform was displayed in the 5 patients performed same-slice dynamic MRI, including imaging characteristics of 'edge to center' enhancement in 2 case. In the other 6 cases, the delayed homogeneous enhancement of lesion was observed. Ten patients obtained radiological follow-up results after GKRS. Reviewing the follow-up data of 8 patients during the period of 3-6 months, the lesions were apparently shrunk in 5 patients with shrinkage rate of 20.8-46.8%. In 4 patients with imaging follow-up during the period of 6-12 months, the lesions of 3 patients were remarkably shrunk with shrinkage rate of 53.5-81.7%. Four patients had imaging follow-up data over 12 months, and all their lesion sizes were reduced with shrinkage rate of 19-83.6%. The clinical presentations of all patients after GKRS were followed up during the period of 1-30 months. In 7 of 9 cases with headache, the symptom was improved; in 5 of 6 cases, facial hypesthesia was improved; in 6 of 9 cases with visual impairments, the visions were markedly improved; and in 8 cases with preoperative diplopia, the symptoms were all resolved. CONCLUSION Although bright hyper-intensities on T2WI and significant homogeneous enhancement on contrast-enhanced T1WI are considered as typical imaging characteristics of CSCH, the dynamic process of progressive delayed enhancement on contrast-enhanced MR is more persuasive in diagnosis. According to our study, GKRS could be chosen as an effective and safe alternative treatment for CSCH. We consider that using relatively low marginal dose may get better effects in tumor shrinkage and protection of cranial nerves.
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Affiliation(s)
- Xiao Anqi
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Shangfu Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xiao Jiahe
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - You Chao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China.
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Héran F, Bergès O, Blustajn J, Boucenna M, Charbonneau F, Koskas P, Lafitte F, Nau E, Roux P, Sadik JC, Savatovsky J, Williams M. Tumor pathology of the orbit. Diagn Interv Imaging 2014; 95:933-44. [PMID: 25195185 DOI: 10.1016/j.diii.2014.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The term orbital tumor covers a wide range of benign and malignant diseases affecting specific component of the orbit or developing in contact with them. They are found incidentally or may be investigated as part of the assessment of a systemic disorder or because of orbital signs (exophthalmos, pain, etc.). Computed tomography, MRI and Color Doppler Ultrasound (CDU), play a varying role depending on the clinical presentation and the disease being investigated. This article reflects long experience in a reference center but does not claim to be exhaustive. We have chosen to consider these tumors from the perspective of their usual presentation, emphasizing the most common causes and suggestive radiological and clinical presentations (progressive or sudden-onset exophthalmos, children or adults, lacrimal gland lesions, periorbital lesions and enophthalmos). We will describe in particular muscle involvement (thyrotoxicosis and tumors), vascular lesions (cavernous sinus hemangioma, orbital varix, cystic lymphangioma), childhood lesions and orbital hematomas. We offer straightforward useful protocols for simple investigation and differential diagnosis. Readers who wish to go further to extend their knowledge in this fascinating area can refer to the references in the bibliography.
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Affiliation(s)
- F Héran
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France.
| | - O Bergès
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - J Blustajn
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - M Boucenna
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - F Charbonneau
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - P Koskas
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - F Lafitte
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - E Nau
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - P Roux
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - J C Sadik
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - J Savatovsky
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
| | - M Williams
- A. de Rothschild Foundation, Imaging Department, 25, rue Manin, 75019 Paris, France
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Xiao HF, Lou X, Liu MY, Wang YL, Wang Y, Chen ZY, Shi KN, Ma L. The role of magnetic resonance diffusion-weighted imaging and three-dimensional arterial spin labelling perfusion imaging in the differentiation of parasellar meningioma and cavernous haemangioma. J Int Med Res 2014; 42:915-25. [PMID: 24903554 DOI: 10.1177/0300060514531918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/24/2014] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the diagnostic value of magnetic resonance diffusion-weighted imaging (DWI) and three-dimensional arterial spin labelling perfusion imaging (3D-ASL) in distinguishing cavernous haemangioma from parasellar meningioma, using histological data as a reference standard. Methods Patients with parasellar meningioma or parasellar cavernous haemangioma underwent conventional T1- and T2-weighted magnetic resonance imaging (MRI) followed by DWI and 3D-ASL using a 3.0 Tesla MRI. The minimum apparent diffusion coefficient (minADC) from DWI and the maximal normalized cerebral blood flow (nCBF) from 3D-ASL were measured in each tumour. Diagnosis was confirmed by histology. Results MinADC was significantly lower and nCBF significantly higher in meningioma ( n = 19) than cavernous haemangioma ( n = 15). There was a significant negative correlation between minADC and nCBF ( r = −0.605). Conclusion DWI and 3D-ASL are useful in differentiating cavernous haemangiomas from parasellar meningiomas, particularly in situations when the appearance on conventional MRI sequences is otherwise ambiguous.
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Affiliation(s)
- Hua-Feng Xiao
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Meng-Yu Liu
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Yu-Lin Wang
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Zhi-Ye Chen
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Kai-Ning Shi
- General Electric Company GE (China) Co., Ltd, Healthcare, Beijing, China
| | - Lin Ma
- Department of Radiology, PLA General Hospital, Beijing, China
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He K, Chen L, Zhu W, Mao Y. Magnetic Resonance Standard for Cavernous Sinus Hemangiomas: Proposal for a Diagnostic Test. Eur Neurol 2014; 72:116-24. [DOI: 10.1159/000358872] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 01/19/2014] [Indexed: 11/19/2022]
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Abstract
The lateral sellar compartment is a complex anatomical structure containing many different elements, any of which can be at the root of a pathological condition. MRI is the examination of choice for this region, and requires the use of specific protocols and systematic examination of each of these elements to produce a suitable diagnosis.
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Affiliation(s)
- A Boulin
- Neuroradiology Department, Hôpital Foch, Suresnes, France.
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Yadav RR, Boruah DK, Yadav G, Pandey R, Phadke RV. Imaging characteristics of cavernous sinus cavernous hemangiomas. Neuroradiol J 2012; 25:515-24. [PMID: 24029085 DOI: 10.1177/197140091202500503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/16/2012] [Indexed: 12/24/2022] Open
Abstract
Cavernous hemangiomas occur rarely in the cavernous sinus and are difficult to diagnose preoperatively. The imaging of these lesions resembles other benign paracavernous lesions such as schwannomas and meningiomas. Profuse intraoperative bleeding may be encountered during surgical resection of these lesions. A preoperative diagnosis is therefore important to alert the surgeon. We report on the imaging characteristics of two different histopathological types of cavernous sinus cavernous hemangiomas and the use of contrast-enhanced MRI, diffusion-weighted MRI and magnetic resonance spectroscopy in the differential diagnosis of these lesions.
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Affiliation(s)
- R R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow, India - -
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Murakami K, Endo T, Tominaga T. An analysis of flow dynamics in cerebral cavernous malformation and orbital cavernous angioma using indocyanine green videoangiography. Acta Neurochir (Wien) 2012; 154:1169-75. [PMID: 22552434 DOI: 10.1007/s00701-012-1354-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/06/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebral cavernous malformations (CCMs) are known to be vascular anomalies with low perfusion because of being angiographically occult. We attempted direct visualization of blood flow within CCMs and orbital cavernous angiomas (CAs), and analyzed flow dynamics using indocyanine green videoangiography (ICG-VAG). METHODS This series included seven CCMs and two orbital CAs. ICG-VAG was performed to visualize blood flow of the lesions before resection. Time to peak of staining was evaluated by reviewing recorded ICG-VAG. RESULTS In five of seven CCMs, stain was identified. CCMs were seen as avascular areas in both arterial and venous phases, and were stained gradually. Stain was maximized late after venous phase. The orbital CAs were also stained lately, but more intensely than CCMs. CONCLUSIONS The present study directly demonstrated slow and low perfusion within CCM and orbital CA using ICG-VAG. On the basis of characteristic flow dynamics of CCMs, intraoperative ICG-VAG provides useful information in microsurgical resection.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Angiography, Digital Subtraction/methods
- Blood Flow Velocity/physiology
- Cerebral Angiography/methods
- Coloring Agents
- Female
- Hemangioma, Cavernous/blood supply
- Hemangioma, Cavernous/diagnostic imaging
- Hemangioma, Cavernous/surgery
- Hemangioma, Cavernous, Central Nervous System/blood supply
- Hemangioma, Cavernous, Central Nervous System/diagnostic imaging
- Hemangioma, Cavernous, Central Nervous System/surgery
- Hemodynamics/physiology
- Humans
- Indocyanine Green
- Male
- Microsurgery/methods
- Middle Aged
- Orbit/blood supply
- Orbital Neoplasms/blood supply
- Orbital Neoplasms/diagnostic imaging
- Orbital Neoplasms/surgery
- Regional Blood Flow/physiology
- Video Recording/methods
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Affiliation(s)
- Kensuke Murakami
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
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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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Eddleman CS, Batjer HH, Awad IA. Cerebral Cavernous Malformations and Venous Anomalies. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Diagnosing a large slowly enhanced cerebral aneurysm using four-dimensional multiphase dynamic contrast-enhanced computed tomography angiography. Jpn J Radiol 2010; 28:680-3. [DOI: 10.1007/s11604-010-0469-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/25/2010] [Indexed: 10/18/2022]
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Abstract
Our aim was to review the imaging findings of relatively common lesions involving the cavernous sinus (CS), such as neoplastic, inflammatory, and vascular ones. The most common are neurogenic tumors and cavernoma. Tumors of the nasopharynx, skull base, and sphenoid sinus may extend to the CS as can perineural and hematogenous metastases. Inflammatory, infective, and granulomatous lesions show linear or nodular enhancement of the meninges of the CS but often have nonspecific MR imaging features. In many of these cases, involvement elsewhere suggests the diagnosis. MR imaging is sensitive for detecting vascular lesions such as carotid cavernous fistulas, aneurysms, and thromboses.
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Affiliation(s)
- A A K Abdel Razek
- Department of Diagnostic Radiology, Masnoura Faculty of Medicine, Mansoura, Egypt.
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