Cavernous sinus hemangioma: a rare entity

  • John F. Vargas Urbina Servicio de Neurocirugía Vascular, Tumores y Funcional, Departamento de Neurocirugía, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú. https://orcid.org/0000-0003-2437-8713
  • Fernando Palacios Santos Servicio de Neurocirugía Vascular, Tumores y Funcional, Departamento de Neurocirugía, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú. https://orcid.org/0000-0003-3957-0767
  • Kenneth López Gutierrez Servicio de Neurocirugía Vascular, Tumores y Funcional, Departamento de Neurocirugía, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú. https://orcid.org/0000-0003-4573-6479
  • Raúl E. Martinez Silva Servicio de Neurocirugía Vascular, Tumores y Funcional, Departamento de Neurocirugía, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú. https://orcid.org/0000-0001-8386-571X
  • William Anicama Lima Servicio de Anatomía Patológica, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú. https://orcid.org/0000-0002-4225-8953
Keywords: cavernous sinus hemangioma, cavernous sinus, Abducens Nerve, Microsurgery, Radiotherapy

Abstract

Cavernous sinus hemangioma is considered as a vascular malformation or as a vascular tumor. It is usually extra-axially located, but it is histologically different from cavernomatous cerebral malformations. Clinical features may include headache, visual alterations or cranial nerve palsy. Diagnostic methods include CT scans, but the best is contrast-enhanced magnetic resonance imaging (MRI). Therapy may be microsurgery or radiotherapy. We present the case of a 30-year-old male, with no relevant past history, who had suffered with headache for three years, and diplopia for the last seven months, due to paresis affecting the sixth cranial nerve. Contrast-enhanced MRI showed an expansive lesion in the right cavernous sinus, with regular borders, T1 hypointense, with significant contrast uptake, T2 and FLAIR hyperintense, with no diffusion restriction. A craniotomy plus total resection of the tumor with hemostatic matrix support for controlling bleeding was performed. This patient developed complete ophthalmoparesis that improved over time. It was concluded that cavernous sinus hemangioma is an unusual condition, with high associated morbidity and mortality rates, but good results may be achieved with an adequate surgical technique.

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References

Montoya F, Vidal A, Sepulveda F, Marileo R, Caro J, Castillo M. Cavernous Sinus Hemangioma: Imaging Diagnosis and Surgical Considerations. World Neurosurgery. 2021; 146:e30-e37. doi: 10.1016/j.wneu.2020.09.153.

Nishimura F, Park YS, Nakagawa I, Yamada S, Nakase H, Nagatomo Y. Hemorrhagic Cavernous Sinus Hemangioma with Sudden-Onset Abducens Palsy. World Neurosurgery. 2018;112:1-5. doi: 10.1016/j. wneu.2018.01.016.

Li P, Ren H, Zhang S, Wang W. Clinical results of Gamma Knife surgery for cavernous sinus hemangiomas: Clinical article. JNS. 2012; 117(Special_Suppl):89-95. doi: 10.3171/2012.7.GKS12992.

Adamski A, Qian J, Adamo MA. Giant Intracranial Extraaxial Parietal-Occipital Cavernous Hemangioma in an Adolescent. World Neurosurgery. 2020;141:3-7. doi: 10.1016/j.wneu.2020.05.188.

Suri A, Ahmad FU, Mahapatra AK. Extradural transcavernous approach to cavernous sinus hemangiomas. Neurosurgery. 2007;60(3):483-489. doi: 10.1227/01.NEU.0000255333.95532.13.

Meincke J, Lützen N, Doostkam S, Urbach H. Teaching Neuroimages: “Filling out” in Cavernous Hemangioma of the Cavernous Sinus. Clin Neuroradiol. 2018;28(1):137-138. doi: 10.1007/s00062-017-0607- 7.

Ohata K, El-Naggar A, Takami T, et al. Efficacy of induced hypotension in the surgical treatment of large cavernous sinus cavernomas. Journal of Neurosurgery. 1999;90(4):702-8. doi: 10.3171/ jns.1999.90.4.0702.

Srinivas D, Sarma P, Shukla D, et al. Multimodality Management of Cavernous Sinus Hemangiomas—An Institutional Experience. J Neurol Surg B. 2017;78(05):399-407. doi: 10.1055/s-0037-1602790.

Bakhsheshian J, Zada G, Pham MH. Cavernous Sinus Hemangioma: Rare Vascular Tumor of Cavernous Sinus. World Neurosurgery. 2018;110:432-3. doi: 10.1016/j.wneu.2017.11.177.

Shi J, Hang C, Pan Y, Liu C, Zhang Z. Cavernous Hemangiomas in the Cavernous Sinus. Neurosurgery. 1999;45(6):1308-1314. doi: 10.1097/00006123-199912000-00006.

Jinhu Y, Jianping D, Xin L, Yuanli Z. Dynamic Enhancement Features of Cavernous Sinus Cavernous Hemangiomas on Conventional Contrast-Enhanced MR Imaging. AJNR Am J Neuroradiol. 2008;29(3):577-581. doi: 10.3174/ajnr.A0845.

Anqi X, Zhang S, Jiahe X, Chao Y. Cavernous sinus cavernous hemangioma: Imaging features and therapeutic effect of Gamma Knife radiosurgery. Clinical Neurology and Neurosurgery. 2014;127:59-64. doi: 10.1016/j.clineuro.2014.09.025.

Wang X, Zhu H, Knisely J, et al. Hypofractionated stereotactic radiosurgery: a new treatment strategy for giant cavernous sinus hemangiomas. Journal of Neurosurgery. 2018;128(1):60-7. doi: 10.3171/2016.10.JNS16693.

Shin M, Kondo K, Hanakita S, et al. Endoscopic transsphenoidal anterior petrosal approach for locally aggressive tumors involving the internal auditory canal, jugular fossa, and cavernous sinus. JNS. 2017;126(1):212-221. doi: 10.3171/2016.1.JNS151979.

Al-MeftyO,SmithRR.Surgeryoftumorsinvadingthecavernous sinus. Surgical Neurology. 1988;30(5):370-381. doi: 10.1016/0090- 3019(88)90200-5.

Published
2024-06-30
How to Cite
1.
Vargas Urbina JF, Palacios Santos F, López Gutierrez K, Martinez Silva RE, Anicama Lima W. Cavernous sinus hemangioma: a rare entity. Acta Med Peru [Internet]. 2024Jun.30 [cited 2024Oct.4];41(2):132-8. Available from: http://www.amp.cmp.org.pe/index.php/AMP/article/view/3042
Section
CASE REPORTS

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