Teaching Neuroimages: “Filling out” in Cavernous Hemangioma of the Cavernous Sinus

Meincke, J.; Lützen, Niklas; Doostkam, Soroush; Urbach, Horst

doi:10.1007/s00062-017-0607-7

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…7 Cavernous sinus venous malformation is characterized by progressive filling enhancement. 8 In this case, the tumour showed a slightly hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging, no blood flow void signals were seen in the tumour, and the enhancement scan showed progressive filling enhancement, with no obvious enhancement of the surrounding meninges. Based solely on the findings from conventional MRI examination, there is a high likelihood of a cavernous sinus venous malformation.…”

Section: Discussionmentioning

confidence: 57%

Is arterial spin labelling necessarily low perfusion for cavernous sinus venous malformation? A case of hyperperfusion cavernous sinus venous malformation

Luo,

Xiao

2023

BJR|Case Reports

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Generally, due to the complexity of the skull base structures, it is difficult to differentiate cavernous vascular malformation and meningioma in the cavernous sinus area using conventional imaging studies. Cavernous sinus venous malformation are characterized by increased capillary masses without a direct arterial supply, typically leading to low perfusion. On the other hand, meningiomas receive arterial blood supply to the tumour and often exhibit high perfusion. So, arterial spin labelling (ASL) can be helpful in distinguishing between the 2 tumour types. However, in our specific case of a cavernous sinus venous malformation, the ASL imaging showed hyperperfusion. Further analysis revealed that this hyperperfusion on ASL can occur when cavernous sinus venous malformation is associated with arteriovenous fistula malformation.

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Section: Discussionmentioning

confidence: 57%

Is arterial spin labelling necessarily low perfusion for cavernous sinus venous malformation? A case of hyperperfusion cavernous sinus venous malformation

Luo,

Xiao

2023

BJR|Case Reports

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“…A brain magnetic resonance imaging (MRI) and/or computed tomography (CT) study was used as the primary diagnostic tool in all the patients. CSHs were mainly diagnosed based on some specific imaging characteristics using MRI where the CSHs had well-defined boundaries in the MRI images (16). On T1-weighted images, the tumor was uniformly hypointense compared with the brain parenchyma, and also showed significantly brighter hyperintensity on T2-weighted images.…”

Section: Diagnosismentioning

confidence: 99%

Fractionated Radiation Therapy for Large and Giant Cavernous Sinus Hemangioma: A Retrospective Study

et al. 2020

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Surgical resection has been traditionally used as a treatment for cavernous sinus hemangioma (CSH). However, this is usually difficult due to tumor vascularity and results in complications especially in large and giant CSH (volume >20 cm 3). Previous studies have reported that radiotherapy (RT) provides an alternative treatment modality for hemangiomas. However, the optimized dose and fractions which control CSH and also protect the cognitive function remain unclear. This study reports our experience in the management of symptomatic large and giant CSH. Methods: Fifty-four patients with symptomatic large (20 cm 3 40 cm 3 , >4 cm in diameter) CSH were enrolled in a retrospective study between January 2007 and December 2018. The prescription dose to the target margin was 50 Gy in 25 fractions. Results: The mean pre-RT tumor volume was 60.9 cm 3 which ranged from 20.2 to 230.5 cm 3. The clinical data obtained was analyzed retrospectively following a mean follow-up period of 35.0 months which ranged from 1 to 140 months. All patients experienced tumor shrinkage within 3 months after radiotherapy. There was an average mean tumor reduction of 79.7% (range, 48.4-98.5%) with no patients experiencing tumor progression and recurrence. All the 54 patients experienced symptomatic improvement within 1 month to 12 months after radiotherapy. Within the entire follow up period, no patients experienced any form of permanent complications or symptomatic radiation toxicity. Neurocognitive impairment studies were conducted before and after radiotherapy on 28 patients while the studies were conducted after the last follow up in 40 patients. The cognitive function of all the participants had normal MoCA-scores of 28.25 pre-radiotherapy. The post-treatment MoCA-scores were also clinically stable (28.04, p = 0.78), and the average MoCA-score did not show any decline until the last follow-up (27.61, p = 0.13). Conclusion: The optimal dose and fractions of radiotherapy treatment for symptomatic large and giant cavernous sinus hemangioma remain unclear. This study, therefore, used a marginal dose of 50 Gy in 25 fractions in radiotherapy and this was proven to be effective and relatively safe in the treatment of symptomatic large and giant CSHs.

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The dural angioleiomyoma harbors frequent GJA4 mutation and a distinct DNA methylation profile

Tauziède‐Espariat

Pierre²,

Wassef³

et al. 2022

acta neuropathol commun

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The International Society for the Study of Vascular Anomalies (ISSVA) has defined four vascular lesions in the central nervous system (CNS): arteriovenous malformations, cavernous angiomas (also known as cerebral cavernous malformations), venous malformations, and telangiectasias. From a retrospective central radiological and histopathological review of 202 CNS vascular lesions, we identified three cases of unclassified vascular lesions. Interestingly, they shared the same radiological and histopathological features evoking the cavernous subtype of angioleiomyomas described in the soft tissue. We grouped them together with four additional similar cases from our clinicopathological network and performed combined molecular analyses. In addition, cases were compared with a cohort of 5 soft tissue angioleiomyomas. Three out 6 CNS lesions presented the same p.Gly41Cys GJA4 mutation recently reported in hepatic hemangiomas and cutaneous venous malformations and found in 4/5 soft tissue angioleiomyomas of our cohort with available data. Most DNA methylation profiles were not classifiable using the CNS brain tumor (version 12.5), and sarcoma (version 12.2) classifiers. However, using unsupervised t-SNE analysis and hierarchical clustering analysis, 5 of the 6 lesions grouped together and formed a distinct epigenetic group, separated from the clusters of soft tissue angioleiomyomas, other vascular tumors, inflammatory myofibroblastic tumors and meningiomas. Our extensive literature review identified several cases similar to these lesions, with a wide variety of denominations. Based on radiological and histomolecular findings, we suggest the new terminology of “dural angioleiomyomas” (DALM) to designate these lesions characterized by a distinct DNA methylation pattern and frequent GJA4 mutations.

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Teaching Neuroimages: “Filling out” in Cavernous Hemangioma of the Cavernous Sinus

Cited by 4 publications

References 7 publications

Is arterial spin labelling necessarily low perfusion for cavernous sinus venous malformation? A case of hyperperfusion cavernous sinus venous malformation

Is arterial spin labelling necessarily low perfusion for cavernous sinus venous malformation? A case of hyperperfusion cavernous sinus venous malformation

Fractionated Radiation Therapy for Large and Giant Cavernous Sinus Hemangioma: A Retrospective Study

The dural angioleiomyoma harbors frequent GJA4 mutation and a distinct DNA methylation profile

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