1
|
Krishnan P, Bhosle R, Patel S, Raju D, Cincu R, Moscote-Salazar LR, Gupta A, Agrawal A. Calvarial hemangiomas: Series of 6 cases and review of literature. World Neurosurg X 2024; 23:100297. [PMID: 38511156 PMCID: PMC10950729 DOI: 10.1016/j.wnsx.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Calvarial haemangiomas are benign, vascular tumours of the skull involving parietal and frontal bones. Mostly these lesions remain asymptomatic, and present with cosmetic deformity, headache, uncommon neurological symptoms and reported as case reports and case series. The radiological appearance can range from sessile growing intradiploically to globular and the lesions may extend outwards or inwards after eroding the outer and inner tables of the skull. "Sunburst appearance" and "Wagon-wheel sign" are classical radiological findings but the lesions may present simply as a lytic expansile or even sclerotic calvarial mass. Because of varied clinical presentation and atypical radiological characteristics, the final diagnosis can be clinched by histology only. In selected cases where these lesions are not cosmetically acceptable, en bloc resection with tumour free margins followed by cranioplasty is the treatment of choice. Most reports of calvarial haemangiomas in literature are in the form of case reports.
Collapse
Affiliation(s)
- Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Rajesh Bhosle
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Shamshuddin Patel
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Dimble Raju
- Department of Neurosurgery, National Neurosciences Centre, Calcutta, West Bengal, India
| | - Rafael Cincu
- Department of Neurosurgery, General University Hospital, Valencia, Spain
| | | | - Amit Gupta
- Department of Neurosurgery, GSVM Medical College, Kanpur, UP, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020, Madhya Pradesh, India
| |
Collapse
|
2
|
Strauss SB, Steinklein JM, Phillips CD, Shatzkes DR. Intraosseous Venous Malformations of the Head and Neck. AJNR Am J Neuroradiol 2022; 43:1090-1098. [PMID: 35863785 PMCID: PMC9575427 DOI: 10.3174/ajnr.a7575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/10/2022] [Indexed: 11/07/2022]
Abstract
Intraosseous venous malformations represent a subtype of venous vascular malformations that arise primarily in bone. In the head and neck, intraosseous venous malformations are most frequently found in the skull, skull base, and facial skeleton, with location at the geniculate ganglion of the facial nerve perhaps the most widely recognized. These non-neoplastic lesions are characterized by dilated venous channels with characteristic internal bony spicules on CT but may present with a more complex appearance on MR imaging and may share features with more aggressive lesions. Further confounding the imaging-based diagnosis of intraosseous venous malformation is the frequent misrepresentation of these lesions as hemangiomas in the radiology and clinical literature, as well as in daily practice. Because most intraosseous venous malformations can be left alone, their correct diagnosis may spare a patient unnecessary concern and intervention.
Collapse
Affiliation(s)
- S B Strauss
- From the Department of Radiology (S.B.S., C.D.P.), Weill Cornell Medical Center/Weill Cornell Medical Center, New York, New York
| | - J M Steinklein
- Department of Radiology (J.M.S., D.R.S.), Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - C D Phillips
- From the Department of Radiology (S.B.S., C.D.P.), Weill Cornell Medical Center/Weill Cornell Medical Center, New York, New York
| | - D R Shatzkes
- Department of Radiology (J.M.S., D.R.S.), Zucker School of Medicine at Hofstra/Northwell, New York, New York
| |
Collapse
|
3
|
Bird CE, Traylor JI, Johnson ZD, Kim J, Raisanen J, Welch BG, Abdullah KG. Surgical Management of a Massive Frontal Bone Hemangioma: Case Report. J Neurol Surg Rep 2022; 83:e72-e76. [PMID: 35832685 PMCID: PMC9272017 DOI: 10.1055/s-0042-1750366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
Intraosseous hemangiomas are rare, benign tumors that can arise from the calvarium. These lesions often invade the outer table of the skull, but typically spare the inner table and intracranial structures. En bloc surgical resection is the standard treatment for intraosseous hemangiomas. However, a piecemeal resection may be required to safely remove the tumor in cases involving the inner table to protect the underlying brain parenchyma and vascular structures. Proper reconstruction is critical to optimize the cosmetic outcome, and a staged procedure allowing implantation of a custom-made implant can be considered for large lesions involving the forehead. We present a case of a patient with a large frontal intraosseous hemangioma with intradural involvement to highlight the surgical nuances of resection and review the existing literature regarding optimal management of these patients.
Collapse
Affiliation(s)
- Cylaina E Bird
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jeffrey I Traylor
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Zachary D Johnson
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jun Kim
- Department of Neurosurgery, Westmead Hospital, Westmead, Sydney, Australia
| | - Jack Raisanen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Babu G Welch
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kalil G Abdullah
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
4
|
Bantan NAA, Abouissa AH, Saeed M, Alwalily MH, Balkhoyour KB, Ashour KM, Hassan AA, Falemban AH, Taher MM. A unique case of multiple calvarial hemangiomas with one large symplastic hemangioma. BMC Neurol 2021; 21:29. [PMID: 33468071 PMCID: PMC7814591 DOI: 10.1186/s12883-021-02053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region. CASE PRESENTATION A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up. CONCLUSIONS Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.
Collapse
Affiliation(s)
| | - Ahmed H Abouissa
- Department of Radiology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Muhammad Saeed
- Department of Radiology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | | | | | | | - Amal Ali Hassan
- Department of Laboratory Medicine, Division of Histopathology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.,Faculty of Medicine, Department of Pathology, Al Azhar University, Cairo, Egypt
| | - Afnan Hisham Falemban
- Department of Laboratory Medicine, Division of Histopathology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Mohiuddin M Taher
- Department of Medical Genetics, Umm-Al-Qura University, Makkah, Saudi Arabia. .,Science and Technology Unit, Umm-Al-Qura University, Makkah, Saudi Arabia.
| |
Collapse
|
5
|
Kim JH, Ahn CH, Kim KH, Oh SH. Multifocal intraosseous calvarial hemangioma misdiagnosed as subgaleal lipoma. Arch Craniofac Surg 2019; 20:181-185. [PMID: 31256555 PMCID: PMC6615426 DOI: 10.7181/acfs.2019.00143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/30/2019] [Indexed: 11/12/2022] Open
Abstract
Intraosseous hemangioma is a rare, slow-growing, benign tumor of blood vessels. Primary hemangioma of the skull is a benign lesion that may appear as a palpable mass or accidentally detected during image evaluation. Simple radiography is the most commonly used technique to localize a lesion and computed tomography (CT) may help determine the effect of a lesion. We report a case of multifocal intraosseous calvarial hemangioma developed in the subgaleal plane of an elderly male patient. Ultrasonography examination revealed hyperechoic striated septae parallel to the skin and discontinuity of the focal cortex, however, the underlying bone cortex appeared relatively intact. No significant flow is observed on Doppler ultrasonography. Based on these evaluations, the mass was interpreted by a radiologist as a subgaleal lipoma. This case highlights the importance of additional CT examination in a patient presenting with a scalloping sign of the underlying calvarium. Clinicians also should be aware of the possibility of intraosseous calvarial hemangiomas in lesion. Furthermore, the proper choice of congenital vascular malformation term is still quite confusing with misconception present in the literature.
Collapse
Affiliation(s)
- Joo-Hak Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Chang Hwan Ahn
- Department of Plastic and Reconstructive Surgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyung-Hee Kim
- Department of Pathology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, School of Medicine, Chungnam National University, Daejeon, Korea.,Brain Research Institute, School of Medicine, Chungnam National University, Daejeon, Korea
| |
Collapse
|
6
|
Akhter AS, El Tecle N, Alexopoulos G, Espinoza G, Coppens J. Intraosseous Orbital Cavernous Hemangioma with Frontal Extension and Dural Involvement. Cureus 2019; 11:e4823. [PMID: 31403012 PMCID: PMC6682381 DOI: 10.7759/cureus.4823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary intraosseous cavernous hemangiomas are rare skull lesions that are not typically known to involve the orbital bones or the dura. We describe a rare case of a fronto-orbital bone cavernous hemangioma with extension into the dura. A 68-year-old female presented with a one-year history of diplopia with discomfort around her left orbit. Magnetic resonance images demonstrated a mass in the left frontal skull extending into the orbital rim. The patient underwent a craniotomy for tumor resection. Dural invasion was found intraoperatively. Gross total resection and reconstruction were achieved. On the postoperative follow-up, the patient was asymptomatic. Primary calvarial intraosseous cavernous hemangiomas are most commonly located in the frontal and parietal bones. These lesions typically involve only the outer table of the skull. In lesions involving the orbit and dura, excision with cranioplasty can provide symptomatic relief with good cosmetic outcomes.
Collapse
Affiliation(s)
- Asad S Akhter
- Neurosurgery, Ohio State University, Wexner Medical Center, Colombus, USA
| | - Najib El Tecle
- Neurosurgery, St. Louis University Hospital, St. Louis, USA
| | | | | | - Jeroen Coppens
- Neurosurgery, St. Louis University Hospital, St. Louis, USA
| |
Collapse
|
7
|
Bravo-Martinez A, Marrero-Gonzalez AP, Suleiman-Suleiman MN, Vicenty-Padilla JC, Trullenque-Martinez E. Radiologic Features with Pathologic Correlation of an Unusual Large Intraosseous Skull Cavernous Hemangioma. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:525-530. [PMID: 30988275 PMCID: PMC6485045 DOI: 10.12659/ajcr.913414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Female, 58 Final Diagnosis: Intraosseous skull hemangioma Symptoms: Palpable, painless hard mass in forehead • no headaches, altered mental status, seizures, or focal neurological deficit Medication: — Clinical Procedure: Cerebral angiogram and embolization of feeders • afterwards, she underwent a bifrontal craniectomy and cranioplasty Specialty: Radiology
Collapse
Affiliation(s)
- Alvaro Bravo-Martinez
- Department of Diagnostic Radiology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Amanda P Marrero-Gonzalez
- Department of Diagnostic Radiology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Juan C Vicenty-Padilla
- Department of Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | |
Collapse
|
8
|
Gomez CK, Schiffman SR, Bhatt AA. Radiological review of skull lesions. Insights Imaging 2018; 9:857-882. [PMID: 30232767 PMCID: PMC6206383 DOI: 10.1007/s13244-018-0643-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
Abstract Calvarial lesions are often asymptomatic and are usually discovered incidentally during computed tomography or magnetic resonance imaging of the brain. Calvarial lesions can be benign or malignant. Although the majority of skull lesions are benign, it is important to be familiar with their imaging characteristics and to recognise those with malignant features where more aggressive management is needed. Clinical information such as the age of the patient, as well as the patient’s history is fundamental in making the correct diagnosis. In this article, we will review the imaging features of both common and uncommon calvarial lesions, as well as mimics of these lesions found in clinical practice. Teaching Points • Skull lesions are usually discovered incidentally; they can be benign or malignant. • Metastases are the most frequent cause of skull lesions. • Metastatic lesions are most commonly due to breast cancer in adults and neuroblastoma in children. • Multiple myeloma presents as the classic “punched out” lytic lesions on radiographs. • Eosinophilic granuloma is an osteolytic lesion with bevelled edges.
Collapse
Affiliation(s)
- Carrie K Gomez
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA.
| | - Scott R Schiffman
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA
| |
Collapse
|
9
|
Ilyas M, Shah SA, Gojwari T, Rafiq S, Ellahi I, Ganaie KH. Classic imaging features of calvarial hemangioma-a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
10
|
Pang C, Loo YL, Corns R, Mohammed R. Solitary calvarial haemangioma presenting as metastatic renal cell carcinoma. BMJ Case Rep 2018; 2018:bcr-2017-223334. [PMID: 29754133 DOI: 10.1136/bcr-2017-223334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Renal cell carcinoma is the most common renal tumour in adult that often metastasises to the lung, liver or bone. Head and neck lesions are uncommon with no early warning signs and presents with overt metastases at primary presentation in 25%-30% of reported cases. The incidence of haemangiomas that suggest malignancy are similar to that of bone metastasis. Calvarial haemangiomas usually present as asymptomatic and discovered incidentally on imaging or postmortem examination. We report a case where an initial diagnosis of benign tumour of the skull was made based on clinical presentation and calvarial haemangioma on CT head but was confirmed as metastatic clear cell carcinoma of the kidney after histopathological results. Skull metastases are rare and present late in the course of the disease. It is unusual for metastatic lesion to be the primary presentation in a clinically silent renal cell carcinoma.
Collapse
Affiliation(s)
- Calver Pang
- Department of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, UK
| | - Yew Loong Loo
- Department of Plastic and Reconstructive Surgery, Pinderfields General Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| | - Robert Corns
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Rasheed Mohammed
- Department of Geriatric Medicine, Airedale NHS Foundation Trust, Keighley, UK
| |
Collapse
|