Intrasellar Cavernous Hemangioma: A Case Report and Literature Review

Abstract

Intrasellar cavernous hemangioma is rare. There are no specific symptoms and the mass effect often mimics pituitary macroadenoma. We present one case of intrasellar cavernous hemangioma that was misdiagnosed. Progressively decreasing vision was the main symptom in this case. The prolactin level was mildly increased but other biochemistry examinations were normal. Magnetic resonance imaging showed an enlarged pituitary fossa and an irregular solid tumor (33 mm × 22 mm × 22 mm) in the sella turcica and parasellar region. Subtotal removal in the case was performed through a transsphenoidal approach. Postoperatively, the patient's visual acuity improved. Through a literature review of 8 intrasellar cavernous hemangiomas, we found most lesions are likely to extend into the suprasellar cistern and cavernous sinus, and total resection is difficult. Transsphenoidal approach surgery should be applied for decompression of the optic nerve and biopsy, and stereotactic radiosurgery is preferable.

Imaging characteristics of Intrasellar cavernous hemangioma

“…Second, many case reports of extra-axial cavernous hemangiomas have emphasized the specificity and sensitivity of a radiological diagnosis based on MRI, although such studies are not sufficiently comprehensive. [ 4 , 11 , 12 ] Although most reports have described the characteristic MRI features (isointensity on T1-weighted images and hyperintensity on T2-weighted images), the gadolinium-enhanced T1-weighted images can be classified into 2 completely different manifestations. [ 19 , 20 ] Specifically, Zhou reported 2 types of cavernous sinus hemangioma: sponge-like (bright homogeneous enhancement) and mulberry-like type (heterogeneous enhancement).…”

“…[ 24 ] Surgical debulking with acute cranial nerve decompression, followed by gamma knife radiosurgery, is considered a safe and effective treatment option for ICH. [ 2 , 4 , 17 ] Radiosurgery can also be performed directly (i.e., without biopsy) in some cases that can be diagnosed based on imaging findings. [ 17 ]…”

“…[ 1 , 2 ] Intrasellar (ICH) and parasellar cavernous hemangiomas are the most common extra-axial forms, although both types (especially ICH) are considered extremely rare. [ 3 , 4 ] The first case of extra-axial cavernous hemangioma was reported in 1980 in a 72-year-old black woman with a metastatic breast carcinoma whose tumor was found incidentally during an autopsy. [ 5 ] Successive cases of ICHs have been reported due to advances in imaging technology and particularly magnetic resonance (MR) applications.…”

“…[ 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.…”