Imaging Characteristics of Cavernous Sinus Cavernous Hemangiomas

Abstract

Cavernous hemangiomas occur rarely in the cavernous sinus and are difficult to diagnose preoperatively. The imaging of these lesions resembles other benign paracavernous lesions such as schwannomas and meningiomas. Profuse intraoperative bleeding may be encountered during surgical resection of these lesions. A preoperative diagnosis is therefore important to alert the surgeon. We report on the imaging characteristics of two different histopathological types of cavernous sinus cavernous hemangiomas and the use of contrast-enhanced MRI, diffusion-weighted MRI and magnetic resonance spectroscopy in the differential diagnosis of these lesions.

Evaluation of Skull Base Tumors with Dynamic TurboFLASH MRI during Gadolinium Injection

“…2 Therefore the diagnosis is a challenge but at the same time it is necessary for a correct therapeutic planning. Because of the extreme vascularization and the close relationship with the cavernous ICA, the rates of complete resection are low, around 16% 19 and a intraoperative mortality is reported around 25%. 20 In our case Turbo-FLASH sequence was useful in ruling out the initial diagnosis of meningioma.…”

“…This filling pattern from the periphery toward the center ("filling in edge to center") a few seconds after the beginning of the venous phase is described by various authors as exclusive of hemangiomas. 8,17,19 With conventional MRI, it is necessary to repeat the same SE sequence more than once to be able to appreciate the gradual filling, making the analysis time longer. The TurboFLASH, with the acquisition time of less than 1 second for each image, not only reduces the acquisition time of the images (40 second in our study) but also provides a filling profile unique to hemangioma which makes it possible to distinguish hemangioma from other tumors that similarly arise in the cavernous sinus but are not endowed with the same filling profile.…”

Clinical-radiological-pathological correlation of cavernous sinus hemangioma: Incremental value of diffusion-weighted imaging

“…Cavernous hemangioma in the cavernous sinus has an estimated prevalence of 1% incidence with significant female preponderance, considered to be due to hormonal influence[ 1 , 2 ]. The lesion is rare in occurrence closely mimicking commonly encountered cavernous sinus lesions such as schwannoma, meningioma, chordoma, granuloma, carotid aneurysm and lympho-proliferative conditions[ 3 , 4 ]. Microscopically cavernous sinus hemangioma (CSH) consists of multiple vascular channels lined by a single layer of endothelium without muscular layer and any intervening neural tissue[ 2 ].…”

Dynamic Contrast-enhanced Magnetic Resonance Imaging in Diagnosis of Cavernous Hemangioma of Cavernous Sinus

“…These highly vascular lesions show intense homogeneous postcontrast enhancement. [4] This intense enhancement is attributed to large amount of thin-walled vascular sinusoids with varying amount of intervening connective tissue according to the type of CHCS. Actually, in early phases, heterogeneous enhancement is noted, then it gradually become homogeneous as reported by Jinhu et al in their sequential axial, coronal, and sagittal images.…”

“…[2] Vertical gaze abnormalities that are reported due to damage to unilateral thalamo-mesencephalic junction include vertical one-and-a-half syndrome, contralesional monocular elevation palsy, coexistence of vertical and horizontal one-and-a-half syndrome, and vertical half-and-a-half syndrome. [3][4][5][6] Rarely, paramedian thalamic infarction can also present as vertical gaze palsies. Hereby, we describe three patients who presented with unique vertical gaze disorder in the form of acute bilateral conjugate supranuclear vertical gaze palsy due to infarct in the unilateral thalamo-mesencephalic junction and isolated medial thalamus.…”