Multiple intracranial capillary hemangiomas and transient cerebrovascular insufficiency

Abstract

Hemangiomas constitute a heterogeneous group of benign vascular proliferations of skin and mucous membranes and very rarely known to develop in the brain or spinal cord. We report here a case of multiple intracranial capillary hemangiomas presenting with transient neurological deficit. The patient underwent stealth MRI brain utilizing 15 ml of Magnevist for stereotactic localization and biopsy was done to establish the diagnosis. It is pivotal to differentiate benign hemangiomas from primary cerebral vascular tumors including hemangioblastoma, hemangioendothelioma and hemangiopericytoma, as later are known for more aggressive biologic behavior.

Durable response of intracranial cellular hemangioma to bevacizumab and temozolomide

“…6 Intracranial hemangiomas are extremely rare; only 20 biopsy-proven cases were found in the literature. 1,2,5,8,10,11,13,17,18,[20][21][22][23][24] With the exception of 4 cases, 11,20,23 the reported primary mode of treatment was neurosurgical resection, of which complete resection was achieved in 12 of the 16 cases. In the other 4 cases, 13,17 only subtotal resection was possible, and additional surgery or radiotherapy was needed to achieve tumor control.…”

“…Of the 3 other cases, reported by Morace et al, 13 2 patients underwent CyberKnife radiotherapy at 5 months and 7 months postsurgery, respectively, and the other underwent CT-guided radiotherapy at 1 year postsurgery. For the 4 patients for whom neurosurgical resection was not used as the primary mode of treatment, 11,20,23 stereotactic radiotherapy was successful in 2, 20 1 died before initiation of treatment, 11 and 1 received no further intervention. 23 Among all 20 cases, there were no reports of spontaneous regression, and the histological subtypes were all reported to be capillary hemangioma, as was the initial pathological diagnosis for the patient reported here.…”

“…For the 4 patients for whom neurosurgical resection was not used as the primary mode of treatment, 11,20,23 stereotactic radiotherapy was successful in 2, 20 1 died before initiation of treatment, 11 and 1 received no further intervention. 23 Among all 20 cases, there were no reports of spontaneous regression, and the histological subtypes were all reported to be capillary hemangioma, as was the initial pathological diagnosis for the patient reported here. The difficulty obtaining a definitive pathological diagnosis made our therapeutic management decisions much more challenging because the literature seems to indicate that therapy should differ between capillary and cellular hemangiomas.…”

“…The difficulty obtaining a definitive pathological diagnosis made our therapeutic management decisions much more challenging because the literature seems to indicate that therapy should differ between capillary and cellular hemangiomas. 2,17,23 This issue seems to stem from the lack of universally accepted nomenclature for these benign vasoproliferative lesions. 15 Although the final pathological diagnoses for the case reported here and the previously reported cases differ, the pattern of rapid recurrence of incompletely resected lesions seems similar, especially for the case reported by Simon et al 17 It is evident from the literature that stereotactic radiotherapy can successfully treat residual or unresectable intracranial hemangiomas.…”

Intracranial Capillary Hemangioma Mimicking a Dissociative Disorder

“…There are limited reports on the incidence of capillary hemangiomas in the central nervous system. 2 Capillary hemangiomas consist of vascular channels lined with a layer of endothelial cells and vascular spaces consisting of capillaries without intervening brain parenchyma. 3 …”