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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 1  |  Page : 95-96

Intrasellar cavernous hemangioma


Medical Imaging Centre, Nanfang Hospital, Southern Medical University, Guangzhou, China

Date of Submission07-Jan-2014
Date of Decision07-Jan-2014
Date of Acceptance02-Feb-2014
Date of Web Publication7-Mar-2014

Correspondence Address:
L C Ma
Medical Imaging Centre, Nanfang Hospital, Southern Medical University, Guangzhou
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.128352

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How to cite this article:
Ma L C, Li W Y, Chen W Q, Wu Y K. Intrasellar cavernous hemangioma. Neurol India 2014;62:95-6

How to cite this URL:
Ma L C, Li W Y, Chen W Q, Wu Y K. Intrasellar cavernous hemangioma. Neurol India [serial online] 2014 [cited 2020 Jun 2];62:95-6. Available from: http://www.neurologyindia.com/text.asp?2014/62/1/95/128352


Sir,

Intrasellar cavernous malformation (CM) is a rare vascular malformation of the sellar region and only seven cases of intrasellar CM have previously been reported, five with imaging data. Because of such rarity this case report.

This patient presented with blurred vision of 3 years duration and also decreased libido and bilateral temporal headache. Blood biochemistry and hormone profile were normal. Brain magnetic resonance imaging (MRI) showed an enlarged pituitary fossa and an irregular solid tumor (35 mm × 18 mm × 27 mm) in the sella turcica and suprasellar region. Pituitary stalk was not visible and the optic chiasm was elevated. The tumor invaded the left cavernous sinus, compressed and encased the cavernous portion of the internal carotid artery. The left temporal lobe was also compressed. The lesion appeared iso-intense to gray matter on T1-weighted image [Figure 1]a and hyper-intense on T2-weighted images (T2WI) [Figure 1]b and c and enhanced homogenously with gadolinium injection [Figure 1]d-f. Patient was operated by an endoscopic endonasal transsphenoidal approach. At operation, the sellar lesion was dark red in color, firm and highly vascular. There was profuse bleeding during the surgical procedure. Pathological examination revealed that the lesion consisting of multiple vessels, filled with red cells, with large lumen and thin wall and some of the vessels were filled with organized thrombi [Figure 1]g.
Figure 1:

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Extra-cerebral CMs account for 5-13% of intracranial vascular malformations. [1],[2] Grossly the CMs are purple or dark red lesions with or without pseudocapsule and the microscopic findings consist of dense and dilated blood vessels lined by a single layer of endothelial cells and no elastic fibers and smooth muscle. [3] The lumen diameters vary in size and the blood flow is slow. The vascular spaces are separated by a matrix of fibrous collagenous tissue without glial. [4],[5] Extra-cerebral CMs are mainly located in the middle cranial fossa, more so in the parasellar region and occasional at the clivus. Literature review showed report of seven cases of intrasellar CMs and five cases with imaging findings. [6],[7],[8],[9] The clinical presenting features of intrasellar CMs is similar to pituitary adenomas. [8] Parasellar CMs with intrasellar extension are different from intrasellar CMs with cavernous sinus extension and this can be determined by measuring the major portion of the tumor mass. In this case, the major part of the tumor was located in the sellar fossa with left and upward extension.

Intracranial CMs can be divided into two types: avascular and highly vascular, the former accounting for about 80%. [9] The highly vascular type of CM on angiography demonstrates rich blood supply, which appears clump-shaped staining shadow in the stage of capillaries and sinus. MRI has been reported to be more specific and sensitive than cerebral angiography and computed tomography in the diagnosis of CMs. [9],[10] On MRI, CMs have the following characteristics: well-defined borders; brightly hyperintense on T2WI images and two patterns enhancement - a rapid homogeneous enhancement and a progressive enhancement. [10] Contrast fills the peripheral part of the lesion in the early stage of dynamic contrast-enhanced scanning and then slowly fills the entire lesion. [10] This pattern of progressive enhancement is very similar to the extra-cranial CM, e.g. the hepatic CM.

 
  References Top

1.Cobbs CS, Wilson CB. Intrasellar cavernous hemangioma. Case report. J Neurosurg 2001;94:520-2.  Back to cited text no. 1
    
2.Jeon SC, Yi JS, Yang JH, Lee IW. Intrasellar cavernous hemangioma. J Korean Neurosurg Soc 2004;36:163-5.  Back to cited text no. 2
    
3.Lombardi D, Giovanelli M, de Tribolet N. Sellar and parasellar extra-axial cavernous hemangiomas. Acta Neurochir (Wien) 1994;130:47-54.  Back to cited text no. 3
    
4.Gould TJ, Johnson LN, Colapinto EV, Spollen LE, Rodriguez FJ. Intrasellar vascular malformation mimicking a pituitary macroadenoma. J Neuroophthalmol 1996;16:199-203.  Back to cited text no. 4
    
5.Buonaguidi R, Canapicci R, Mimassi N, Ferdeghini M. Intrasellar cavernous hemangioma. Neurosurgery 1984;14:732-4.  Back to cited text no. 5
    
6.Chuang CC, Jung SM, Yang JT, Chang CN, Pai PC. Intrasellar cavernous hemangioma. J Clin Neurosci 2006;13:672-5.  Back to cited text no. 6
    
7.Chhang WH, Khosla VK, Radotra BD, Kak VK. Large cavernous haemangioma of the pituitary fossa: A case report. Br J Neurosurg 1991;5:627-9.  Back to cited text no. 7
    
8.Sohn CH, Kim SP, Kim IM, Lee JH, Lee HK. Characteristic MR imaging findings of cavernous hemangiomas in the cavernous sinus. AJNR Am J Neuroradiol 2003;24:1148-51.  Back to cited text no. 8
    
9.Sansone ME, Liwnicz BH, Mandybur TI. Giant pituitary cavernous hemangioma: Case report. J Neurosurg 1980;53:124-6.  Back to cited text no. 9
    
10.Mitsuhashi T, Hashimoto R, Nagahama S, Nagata Y. Intrasellar cavernous angioma in neurofibromatosis. Hum Pathol 1991;22:623-4.  Back to cited text no. 10
    


    Figures

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