Sellar and parasellar extra-axial cavernous hemangiomas

Abstract

Cavernous hemangiomas can grow extra-axially within dural sinuses, particularly the cavernous sinus and present like tumours. Five cases of cavernous hemangiomas arising within or from the wall of the cavernous sinus are reported. Three of them had an "endophytic" growth within the cavernous sinus with a lateral extension into the middle cranial fossa, a medial extension into the sella and an anterior extension into the superior orbital fissure. Two cases presented with an "exophytic" extension from the sinus wall at the point of entry of the third and fourth cranial nerves respectively. These patterns of growths are best appreciated by MRI. Keeping in mind that these lesions are contained within a pseudocapsule will help in planing surgical strategy. Characteristic MRI findings of cavernous hemangiomas in this location include hypo-intensity on T 1-weighted images, marked hyperintensity on T2-weighted images and Gadolinium enhancement.

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

“…This dynamic process of progressive delayed enhancement on contrast-enhanced MRI is sometimes more persuasive in the diagnosis, especially for large CaSHs [1]. Unlike meningiomas in CS, CaSHs rarely show a dural tail sign or narrow the ICA [2,18]. In addition, the dark low signal rim around the more spherical lesion of CaSH on T2 definition is another important feature that can be used to differentiate CaSHs from cavernous sinus meningiomas, but not so valuable as their extremely high homogeneous intensity on T2-weighted and FLAIR images in our series.…”

Gamma Knife Surgery for Cavernous Hemangiomas in the Cavernous Sinus

“…The typical imaging appearance of CS hemangiomas includes low-to isodense-mass lesions on T1-weighted image, extremely high intensity on T2-weighted image (as bright as cerebrospinal fluid signal), and strong homogeneous or heterogeneous enhancement after Gd-DTPA injection. [17][18][19][20] The typical imaging finding of a dural tail sign of meningiomas is rarely observed in CS hemangiomas. 18,21,22 Some authors have proposed that other parasellar tumors, including chordomas, lymphomas, metastases, and some meningiomas, may also exhibit markedly increased signal intensity on T2-weighted MRI but are less homogeneous and not so sharply delineated.…”

“…[17][18][19][20] The typical imaging finding of a dural tail sign of meningiomas is rarely observed in CS hemangiomas. 18,21,22 Some authors have proposed that other parasellar tumors, including chordomas, lymphomas, metastases, and some meningiomas, may also exhibit markedly increased signal intensity on T2-weighted MRI but are less homogeneous and not so sharply delineated. 8,23,24 As a CS hemangioma grows, the internal carotid artery is usually encased but without narrowing.…”

“…The typical imaging finding of a "dural tail sign" in meningiomas was rarely observed in CS hemangiomas. 18 As a CS hemangioma grows, the internal carotid artery is usually encased but without narrowing. In contrast, when a meningioma grows, it usually compresses and narrows the internal carotid artery ( Figure 1).…”

“…CS hemangioma was diagnosed when the brain MRI showed characteristic imaging findings of low-to isodense-mass lesions on T1-weighted image, extremely high intensity on T2-weighted image (as bright as cerebrospinal fluid signal), and strong homogeneous or heterogeneous enhancement after Gd-DTPA injection. [17][18][19][20] The characteristic hyperintense signal on the T2-weighted image was used to differentiate CS hemangiomas from the more common CS meningiomas ( Figure 1). In meningiomas, the T2-weighted images showed less intensity compared with CS hemangiomas.…”