Endoscopic management of Atypical sellar cavernous hemangioma: A case report and review of the literature

Al-Sharydah, Abdulaziz Mohammad; Al-Suhibani, Sari Saleh; Al-Jubran, Saeed Ahmad; Al-Abdulwahhab, Abdulrahman Hamad; Al-Bar, Mohammed; Al-Jehani, Hosam; Al-Issawi, Wisam

doi:10.1016/j.ijscr.2017.12.006

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…CT is used more commonly in early cases, and most of them exhibit hyperdense lesions with homogeneous or mild enhancement. [ 13 ] The case reported here involves the first comprehensive imaging examination of ICH with MRI, CT, and DSA findings.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] Successive cases of ICHs have been reported due to advances in imaging technology and particularly magnetic resonance (MR) applications. [ 4 , 6 – 13 ] ICH has a characteristic appearance on MR imaging (MRI), including isointensity on T1-weighted images, hyperintensity on T2-weighted images and diffuse homogeneous enhancement on gadolinium-enhanced T1-weighted images in the sellar region. Still, these lesions are frequently misdiagnosed and treated as pituitary adenomas.…”

Section: Introductionmentioning

confidence: 99%

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Imaging characteristics of Intrasellar cavernous hemangioma

Pan¹,

Shen²,

Ma³

et al. 2020

Medicine

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Rationale: Intrasellar cavernous hemangiomas (ICHs) are rare vascular lesions that arise in the sellar region. ICHs are usually misdiagnosed and treated as pituitary adenomas. Therefore, a preoperative diagnosis is particularly important, especially when the goal is complete resection. Patient concerns: A 55-year-old woman presented with a 1-month history of intermittent dizziness. Magnetic resonance imaging (MRI) revealed a well-demarcated abnormal ellipsoid signal in the sellar region (size: 2.7 cm × 1.7 cm), with a mulberry-like enhancement after gadolinium injection. Computed tomography revealed an intrasellar mass without calcification that extended into the left cavernous sinus and was faintly contrast-enhanced. Angiography revealed a tumor with mildly delayed staining fed by the C5 segment of the right internal carotid artery. Diagnosis: An intrasellar cavernous hemangioma based on neuroradiological examinations. Interventions: The patient underwent surgery with an endoscopic endonasal transsphenoidal approach to debulk the lesion and obtain tissue for the pathological diagnosis. Outcomes: Blood spurting was observed after puncture, and the capsule was stained blue. Lesion removal was stopped, and the patient underwent gamma knife surgery 1 week later. She remained in good condition during the follow-up. Lessons: Sponge-like or mulberry-like lesions can be identified on MRI after gadolinium injection and can facilitate a preoperative diagnosis of ICH. Currently, surgical debulking with cranial nerve decompression during the acute stage and subsequent gamma knife radiosurgery are considered to be a safe and effective treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Imaging characteristics of Intrasellar cavernous hemangioma

Pan¹,

Shen²,

Ma³

et al. 2020

Medicine

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“…To date, there are approximately 70 cases of histologically confirmed OPH CM. Still, only three papers[2,11,17] reported the cases of OPH CM treated by means of an endoscopic endonasal, transsphenoidal approach. Natural history of OPH CM is not clear partly because most reported cases have been surgically treated and partly because there is a small amount of data.…”

Section: Discussionmentioning

confidence: 99%

“…[4,7,9,12,13,15] There are three papers reporting the use of an endoscopic endonasal transsphenoidal approach: the first one[17] showed gross-total resection reporting only a transient postoperative worsening of the left temporal field defect, whereas the second one[11] reported a gross-total resection and no postoperative deficit. The third paper[2] instead presented a case of a large CM that extended into the sella and the sovrasellar region without signs of bleeding. Still, the patient was operated on for neurological deterioration from direct tissue compression (decreased visual acuity in the left eye, bitemporal homonymous hemianopsia, and 6 th nerve palsy).…”

Section: Discussionmentioning

confidence: 99%

“…[16] In the past few years, both the accesses, the exploration and the working possibilities in the sellar and parasellar areas became easier with the evolution and the spreading of the neuroendoscopic techniques. However, only three papers to date[2,11,17] reported a suprasellar decompression by a ventral endoscopic approach. We report our experience dealing with the decompression of the optic structures through an endoscopic, endonasal, transsphenoidal approach in a case of acute hemorrhage caused by a cavernous angioma.…”

Section: Introductionmentioning

confidence: 99%

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Transnasal endoscopic removal of a retrochiasmatic cavernoma: A case report and review of literature

Zoia

Bongetta

Dorelli

et al. 2019

Surgical Neurology International

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Background: Cavernomas arising in the region of the optic apparatus are extremely rare, accounting for <1% of all the central nervous system cavernomas. Most patients are affected by acute visual disturbances related to hemorrhagic events. A prompt resection of the lesion together with a decompression of the optic apparatus may lead to a functional improvement. Almost all patients reported in literature were treated by means of a craniotomy, whereas only few papers described the use of a transnasal approach. Case Description: We report the case of a 53-year-old woman with a hemorrhagic, cavernous malformation of the optic chiasm region and we discuss the technical nuances of the endoscopic transnasal approach we employed. We also review literature for patients with cavernomas treated with a transsphenoidal approach. In our case, the patient underwent the gross-total resection of the lesion through a fully endoscopic transnasal route and the visual disturbances improved immediately after the operation. The ventral access allowed an adequate exposure of the chiasm/anterior circulation complex, thus avoiding an excessive dissection and retraction of neurovascular structures. Moreover, with the aid of angled scopes, we were able to identify the frail vascular supply of the chiasm by employing the suprachiasmatic corridor as well as the infrachiasmatic one. We stress the need for a careful reconstruction of the skull base to avoid a postoperative cerebrospinal fluid leak. Conclusions: With the evolution and spreading of the neuroendoscopic techniques, in selected cases, we advocate the use of the transnasal route for the removal of cavernomas arising in the region of the anterior optic pathways.

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Evaluation of Sellar Masses

Nippoldt

2022

Endocrinology and Diabetes

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Endoscopic management of Atypical sellar cavernous hemangioma: A case report and review of the literature

Cited by 10 publications

References 14 publications

Imaging characteristics of Intrasellar cavernous hemangioma

Imaging characteristics of Intrasellar cavernous hemangioma

Transnasal endoscopic removal of a retrochiasmatic cavernoma: A case report and review of literature

Evaluation of Sellar Masses

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