Cavernous hemangioma extending to extracranial, intracranial, and orbital regions

Abstract

Extraaxial cavernous hemangiomas are rare intracranial lesions that can be located in different cranial compartments. Extension across different tissue planes such as the subcutaneous tissue, skull, orbital cavity, intracranial dura mater, and extracranial trigeminal divisions within the same patient has not been previously reported. This 32-year-old woman suffered left exophthalmos, left sixth nerve palsy, and trigeminal neuropathy. Magnetic resonance imaging studies revealed an extensive multicompartmental lesion, with enhancement following Gd administration. A left orbitopterional approach allowed removal of several cavernomatous lesions located in the orbit, frontotemporal dura, and lateral wall of the cavernous sinus. A histologically based diagnosis of extraaxial cavernous hemangioma was made. In the postoperative period the patient experienced a regression of her symptoms. The authors report on a case of cavernous hemangioma with a unique extension to different intracranial/extracranial compartments. Although radical removal of the lesion was not feasible, partial excision allowed for satisfactory clinical control of the patient's symptoms.

A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases

“…Since CaSHs are benign tumors and curable if total resection is achieved, open surgery is recommended as a primary treatment option by some centers [23,29,37]. However, complete resection of these tumors is a great challenge because of excessive intraoperative hemorrhage and the potential of injury to cranial nerves due to the complicated neurovascular structures of the cavernous sinus [17,20,22,[25][26][27]37], despite recent advances in microsurgical techniques [4,23,29,37]. In most previous studies the total resection rate was only 30 %-64 % [4,23,29,33], and the incidence of postoperative complications was as high as 71 % [4].…”

Gamma Knife Surgery for Cavernous Hemangiomas in the Cavernous Sinus

“…2 The optimal treatment strategy is still controversial. Microsurgical approach may result in severe bleeding and even operative death, [3][4][5][6][7] whereas total removal rate by surgical excision is only 30% to 44%. 1,4,8 Difficulty in radical excision is due mainly to massive intraoperative hemorrhage or tumor adherence to neurovascular structures, 1,4,8 so postoperative cranial neuropathies, especially sixth cranial nerve injury, occur frequently because the nerve often lies within the tumor substance.…”

Cavernous malformation of the trigeminal nerve

“…Most interesting is the paper of Kasantikul et al on an unusual neurilemmoma of the trigeminal nerve that included a cavernous angioma, cartilage, bone and adipose tissue relating this association to ectomesenchymal properties of the neural crest. Poca et al 6 have also illustrated a case of CCM involving the extracranial divisions of the trigeminal nerve.…”