Extra-axial cavernous hemangiomas involving the dural sinuses

Abstract

Extra-axial cavernous hemangiomas are rare lesions previously associated with unacceptable mortality and morbidity rates that precluded surgical resection. The authors analyze the clinical presentation, surgical results, and histology of eight intrasinus cavernous hemangiomas: six located in the cavernous sinus, one in the petrosal sinus, and one in the torcula. Magnetic resonance imaging is the best radiographic test for surgical planning. Successful tumor removal was achieved in six cases with no mortality and low morbidity. In the remaining two patients, only subtotal resection was achieved because of massive hemorrhage in one and the misdiagnosis of a pituitary adenoma leading to a transsphenoidal approach in the other. For hemangiomas arising within the cavernous sinus, extradural removal of the sphenoid bone facilitated preservation of the neurovascular structures. Since the clinical and histological characteristics of these lesions are distinct from intra-axial cavernous hemangiomas, a more appropriate term may be "sinus cavernoma" to indicate that these lesions are primarily intrasinus in origin.

Cavernoma gigante: relato de dois casos

“…Os cavernomas, hemangiomas cavernosos ou angiomas cavernosos são malformações vasculares cerebrais do grupo das malformações angiograficamente ocultas 8 . Possuem caráter esporádico ou familiar.…”

“…Quando infratentoriais, a localização mais comum é no tronco cerebral (ponte). Outras localizações mais raras estão no cerebelo 4 , medula espinhal 5 , tentório 6 , região do clívus 7 , extra axiais envolvendo os seios durais 8 , intraventriculares 9,10 , em região da pineal 11 , na duramáter 12 , na calota craniana 13 . Podem apresentar calcificações 14 , ser múltiplos, classificados como hemangiomatose 15 e múltiplos com calcificações 16 .…”

Extradural Approach for Cavernous Hemangioma of the Cavernous Sinus: Experience With 13 Cases.

“…Cavernous hemangioma is usually angiographically`occult' despite the extensive vascularity, 15,28) although mild tumor blush is frequently seen. 6,12,14,16,17,25,28) As in our cases, the inferolateral trunk, 6,8,11) meningohypophyseal trunk, 15,17,18) accessory meningeal artery, 18,25) and middle meningeal artery 5,12,15,17) have been identified as major feeding vessels. In two of our cases, there was a relatively large feeder from the region of origin of McConnell's capsular artery.…”

“…Erosion of the bones of the middle fossa floor, sphenoid wing, and the temporal squama and wasting of the temporalis and masseter muscles in some cases suggests the slow growth and progression of these tumors. 15) Cavernous hemangioma is hyperdense on CT with brilliant enhancement after contrast administration. The lesion is hypointense on T 1 -weighted MR images and highly hyperintense on T 2 -weighted images.…”

“…Cavernous hemangiomas involving the dural confines of the cavernous sinus, frequently reach giant size before diagnosis. Radiation treatment has been successful, 5,15,17) but the general consensus favors radical surgery as the primary and only modality of therapy for these histologically benign tumors. Here, we analyze our experience with 13 cases of cavernous hemangiomas.…”