Cavernous Hemangiomas of the Pediatric Calvaria

Abstract

This series reports 2 pediatric cases of calvarial cavernous hemangioma (cavernoma, cavernous malformation) treated surgically at Children's Hospital Colorado between 2008 and 2010. Both cases presented as painless bony masses which enlarged over time. Both patients underwent surgical resection without complication and have remained recurrence free since surgery. Because so few cases have been reported among pediatric populations, little is known regarding the epidemiology and prognosis of calvarial cavernous hemangiomas in children. These cases represent interesting additions to the small body of literature on these rare tumors.

Calvarial hemangiomas: Series of 6 cases and review of literature

“… 3 , 5 , 13 , 14 , 15 , 17 However, there are reports of finding sclerotic lesions mimicking an osteoma as well and also lesions that expand the diploic space with a central sclerosis resembling osteoblastoma. 21 We found expansile lytic lesions in two of our 3 patients who had preoperative CT imaging done. Large lesions have radiating spicules of bony trabeculae giving it the classical sunray (or sunburst) appearance on CT scans and plain radiography of skull.…”

“…Excluding the papers that deal with radiological approach to diagnosis of calvarial lesions, skull base haemangiomas, other lesions mimicking these like haemangioendothelioma, angiosarcomas, epithelial hyperplasia's, subgaleal haemangiomas, intraosseous venous malformations, aneurysmal bone cysts and those not in the English language we collected a total of 49 reports of 61 cases that are enumerated in Table 2 . 1 , 2 , 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 The classical radiological appearance of CHs consists of an expansile lytic lesion on computed tomography (CT) scans. 3 , 5 , 13 , 14 , 15 , 17 However, there are reports of finding sclerotic lesions mimicking an osteoma as well and also lesions that expand the diploic space with a central sclerosis resembling osteoblastoma.…”

“…3, 6, 9 Several authors hold that these tumours are congenital in origin 1 , 8 but due to slow indolent growth 9 and lack of symptoms may present late in life. 6 A number of authors have described paediatric calvarial haemangiomas 5 , 9 , 18 , 20 , 21 , 23 , 29 , 31 , 36 , 40 , 41 , 45 , 46 , 47 , 48 , 49 some as young as 4 months of age 47 , 48 who had a skull swelling since birth. 3 of our 6 patients were adults and 3 were less than 18 years of age.…”

“…Curettage of the lesion alone results in greater blood loss and a propensity for recurrence. 4 , 5 , 6 Hence most authors have mentioned complete resection as the procedure that they carried out but there are reports of curettage alone along with removal of the outer table 21 , 25 , 26 particularly in cases where the inner table was preserved and also craniotomy followed by debulking of the diploe and replacement of the outer layer. 31 Atci et al 1 have recommended taking margins of the adjacent non-involved bones during surgery while Namaa et al 6 advocate resection with a 1 cm margin of normal bone to prevent recurrence and decrease intraoperative haemorrhage as the sinusoids in the tumour are not disturbed.…”

“…Materials for CP mentioned in literature vary from split calvarial graft 32 , 39 , 44 to titanium mesh 15 , 16 and bone cement 36 , 37 , 44 Most authors describe resection and CP at the same sitting. 12 , 14 , 15 , 20 , 33 , 39 , 45 However, there are reports of staged cranioplasty too 11 , 21 , 42 usually due to torrential haemorrhage or doubt regarding the nature of the lesion.…”