Atormac
brintellex
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 5161  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (801 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1781    
    Printed41    
    Emailed0    
    PDF Downloaded36    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 4  |  Page : 442-443

Cavernous sinus but not intrasellar cavernous hemangioma


Department of Neurosurgery, West China Hospital, Chengdu City, Sichuan Province, China

Date of Submission10-Jun-2013
Date of Decision14-Jun-2013
Date of Acceptance21-Jul-2013
Date of Web Publication4-Sep-2013

Correspondence Address:
Bo-Wen Cai
Department of Neurosurgery, West China Hospital, Chengdu City, Sichuan Province
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.117603

Rights and Permissions



How to cite this article:
Zhou BY, Cai BW, Liu YH, Fan YJ. Cavernous sinus but not intrasellar cavernous hemangioma. Neurol India 2013;61:442-3

How to cite this URL:
Zhou BY, Cai BW, Liu YH, Fan YJ. Cavernous sinus but not intrasellar cavernous hemangioma. Neurol India [serial online] 2013 [cited 2021 Jan 18];61:442-3. Available from: https://www.neurologyindia.com/text.asp?2013/61/4/442/117603


Sir,

Intrasellar cavernous hemangiomas are extremely rare and the origin of the lesion is uncertain and the optimal treatment is controversial. We present a rare case of intrasellar cavernous hemangioma.

A 33-year-old female patient presented with dizziness, blurred vision of 2 months duration. Magnetic resonance imaging (MRI) revealed intrasellar and suprasellar lesion surrounding left internal carotid artery, with hyperintense in T2-weighted images, isointense in T1-weighted images, obviously homogeneous enhancement on gadolinium-enhanced T1-weighted images [Figure 1]a-c. The lesion volume was 9.55 ml (24 mm × 19 mm × 40 mm) (the formula used to compute volumes was the standard volume of an ellipsoid, as follows: V = 1/6 pi a × b × c, where a, b and c are the three diameters [1] ). Computerized visual-field examination showed bilateral vision field defect. The endocrinological studies revealed hyperprolactinemia (prolactin 119.90 ng/ml). Relevant medication history, which affects prolactin levels, was denied. A non-functional pituitary adenoma was diagnosed pre-operatively. Direct trans-nasal transsphenoidal approach surgery was performed under the microscope. Needle puncture revealed highly vasculized mass. The dura over the sella was opened and a firm, fibrous vascular mass was encountered. Lesion was too tenacious to scrape and an attempt to tear the lesion was made but to no avail. There was profuse bleeding during the surgical procedure. A biopsy was performed to avoid disrupting the saddle diaphragm. Pathologic analysis of a frozen specimen revealed a tendency of angiogenic tumor. Histological studies revealed grossly large dilated blood vessels, intermingled with micro-hemorrhage. Immunohistochemical techniques reveal a CD34(+), supporting the diagnosis of cavernous hemangioma [Figure 2]. There were no post-operative complications. Patient was treated by gamma knife with margin doses of 12 Gy and isodose curves 50% [Figure 3]. At 6 months after surgery and gamma knife, MRI showed a lesion shrink to 0.87 ml (11 mm × 9 mm × 17 mm). The part involving the sella turcica disappeared and the left cavernous sinus was still involved [Figure 1]d and e.
Figure 1: (a‑c) Pre‑operative magnetic resonance imaging showing (a) hyperintense in T2‑weighted images, (b) isointense in T1‑weighted images, (c) obviously homogeneous enhancement on gadolinium‑enhanced T1‑weighted images. (d and e) 6 months after surgery and gamma knife, magnetic resonance imaging showing lesion shrink

Click here to view
Figure 2: Histological examinations (H and E, 100). Immunohistochemical techniques reveal a CD34‑positive, denoting existence of endothelial cells of blood vessels

Click here to view
Figure 3: Gamma knife was performed

Click here to view


The term of "intrasellar cavernous hemangiomas" was used to refer to cavernous hemangiomas mainly or soundly involving the intrasellar in the cases ever reported. The authors believe it is a type of cavernous sinus hemangiomas growing into the sella. [2] Cavernous sinus hemangiomas may originate from components of the cavernous sinus itself or from the surrounding tissues. [3] There are two patterns of growths, when cavernous hemangiomas grow within the dural sinuses: Exophytic extension and endophytic growth. They can grow within the cavernous sinus with a medial extension into the sella, a lateral extension into the middle cranial fossa and an anterior extension into the superior orbital fissure. Intrasellar cavernous hemangiomas are extremely rare and there are eight cases reported. [4],[5] The authors present a very rare case of an intrasellar cavernous hemangioma with invading left cavernous sinus. At 6 months after the gamma knife treatment, the part involving the sella turcica disappeared and the left cavernous sinus was still involved. In fact, it is more appropriate to consider it as a cavernous sinus lesion involving the sellar region.

Intrasellar cavernous hemangiomas are highly euangiotic lesions, often resulting in massive hemorrhage while excision. Puncture before resection may provide more information and thus reduce the bleeding risk. One should be wary of the possibility of cavernous hemangiomas, once a blood supplied abundant, tenacious lesions was contoured during operation. Intraoperative pathological findings of a frozen specimen are essential for surgical strategy. Even for an experienced neurosurgeon, total resection is difficult and dangerous. A partial resection or biopsy can be performed to avoid unmanageable bleeding, once a hemangioma is identified.

Gamma knife proved to be effective for hemangiomas of the cavernous sinus and orbit by some reports while avoiding the potentially serious complications associated with surgery. [6],[7] The present patient underwent gamma knife post-operatively without short-term complications. After 6 months of the gamma knife treatment, the lesion volume shrank from 9.55 ml markedly to 0.87 ml. Gamma knife with margin doses of 12 Gy and isodose curves 50% is reasonable.

 
  References Top

1.Sorensen AG, Patel S, Harmath C, Bridges S, Synnott J, Sievers A, et al. Comparison of diameter and perimeter methods for tumor volume calculation. J Clin Oncol 2001;19:551-7.  Back to cited text no. 1
[PUBMED]    
2.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. 2
[PUBMED]    
3.Salanitri GC, Stuckey SL, Murphy M. Extracerebral cavernous hemangioma of the cavernous sinus: Diagnosis with MR imaging and labeled red cell blood pool scintigraphy. AJNR Am J Neuroradiol 2004;25:280-4.  Back to cited text no. 3
[PUBMED]    
4.Jeon SC, Yi JS, Yang JH, Lee IW. Intrasellar cavernous hemangioma. J Korean Neurosurg Soc 2004;36:163-5.  Back to cited text no. 4
    
5.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. 5
[PUBMED]    
6.Thompson TP, Lunsford LD, Flickinger JC. Radiosurgery for hemangiomas of the cavernous sinus and orbit: Technical case report. Neurosurgery 2000;47:778-83.  Back to cited text no. 6
[PUBMED]    
7.Chou CW, Wu HM, Huang CI, Chung WY, Guo WY, Shih YH, et al. Gamma knife surgery for cavernous hemangiomas in the cavernous sinus. Neurosurgery 2010;67:611-6.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow