Hemangioma of the cavernous sinus in a child

Abstract

An 11-year-old boy presented with diplopia and right cranial nerve VI paresis. MRI demonstrated a T2-hyperintense extra-axial mass in the cavernous sinus. Early heterogeneous enhancement progressed to late homogeneous enhancement. The carotid artery was not narrowed (figure). Slow growth prompted endoscopic transsphenoidal resection. Microscopy demonstrated a vascular tumor with bland endothelial cells and no mitoses.Hemangiomas of the cavernous sinus rarely occur in children. Marked T2 hyperintensity and progressive nodular centripetal enhancement are common.1 Preoperative diagnosis is important to avoid hemorrhage at surgery. They are often mistaken for more common meningiomas, which usually show T2-isointensity and carotid artery narrowing.

Prediction of the Clinical Outcome of Cavernous Sinus Lesions in Children

“…Presenting signs and symptoms, diagnostic procedures, final diagnoses, and the clinical course of the whole group of 21 patients are summarized in ►Table 1. Data for Patients 1 through 17 were taken from the published case reports [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (4 female, mean age 6.8 years AE 3.4 standard deviation [SD] and 13 male, 9.3 years AE 2.7), Patients 18 through 21 (2 female, both 13 years old, and 2 male, 9 years and five weeks old, respectively) were seen by the authors. The mean age was 8.7 years AE 3.6 (5 weeks to 13 years).…”

“…Only publications reporting cases of patients 16 years of age or younger at the time of presentation, written in English, and offering sufficient information about clinical course, outcome, and follow-up findings were included. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In the children treated by the authors, MRI was performed using the following protocol: T2-weighted sequences in axial, sagittal, and coronal directions, 3 mm slice thickness. Fluidattenuated inversion recovery (FLAIR) was used in all children older than 2 years.…”

“…Painful ophthalmoplegia due to a proven CS syndrome is very rare in childhood, and management guidelines are therefore not available. In this study we describe the clinical course in 4 of our own pediatric patients with ophthalmoplegia due to CS lesion and analyze 17 additional patients reported in the literature [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] to gain insight into the spectrum of this entity. To the best of our knowledge, this is the largest overview on CS lesions in children so far.…”