Intracranial Capillary Hemangioma – a Case Report and Literature Review

Abstract

BackgroundCapillary hemangiomas of the central nervous system are exceedingly rare. These are benign tumour-like lesions that usually occur in the skin and soft tissues of mainly children. We report the case of an extra-axial capillary hemangioma mimicking a tentorial meningioma.Case presentationA 46-year old female patient presented with headaches. Imaging revealed an avidly enhancing tentorial lesion with a wide dural base, features suggestive of a meningioma. Intra-operatively, an extra-axial heavily vascular tumour was found and was radically resected en bloc. Histology revealed thin-walled capillary-sized vessels arranged in closely packed lobules, and a diagnosis of capillary hemangioma was made. At one year follow up, the patient was asymptomatic and no tumour recurrence was noted.ConclusionsA literature review showed that capillary hemangiomas may be misdiagnosed as other extra-axial dural-based lesions such as meningiomas, schwannomas, hemangiopericytomas and inflammatory granulomatous lesions. Diagnosis should be considered especially in radiologically atypical cases. Complete excision is curative. Stereotactic radiosurgery on its own or in conjunction with surgery also achieves good results while partial excision or biopsy alone often leads to recurrence.

Papilledema with acute profound visual loss in capillary haemangioma of the sphenoid sinus with sellar and parasellar extensions – a triple rarity presentation

“…Our case demonstrated the important role of neuroimaging in the diagnosis of vascular tumours, consistent with other studies. [3][4][5]7,9 Surgical resection is indicated in symptomatic but has a higher risk of massive bleeding as reflected in our case. Cases with incomplete tumour resection or in those cases involving regions of the brain or skull base where a complete resection cannot be accomplished may benefit from stereotactic radiotherapy.…”

“…Recurrences have previously been reported, usually affecting females. 7,12 This is the first ever case of ICH recurrence in an adult male.…”

“…However, none of the visual loss was associated with papilledema. 7 In pituitary apoplexy, a patient may develop acute visual loss, but most of the time there will be optic disc pallor due to longstanding tumour compression of the visual pathway. 8 To our knowledge, this is the first case of papilledema with severe visual loss resulting from raised intracranial pressure due to ICH's rapid growth and tumoral bleed.…”