Effective treatment of intracranial capillary hemangioma with prednisone in 2 cases

Introduction: Capillary hemangiomas are benign tumours originating from blood vessels which commonly present in the first month of life on the face, scalp, back or chest. Intracranial capillary hemangioma without generalized neuro-cutaneus hemangiomatosis is extremely are. We report two patients who were diagnosed prenatally and at the age of 3 month of life with intracranial hemangioma and treated successfully with prednisone.

Case reports: Patient 1 is a 2 year old boy who was diagnosed in prenatal ultrasound for an intracranial extra-axial highly vasculated tumour originating from the right temporal base with destruction of the right orbital wall. He was delivered at week 37 by Caesarean section an showed a slight proptosis with normal neurological examination. MRI, CT scan and angiography confirmed the prenatal findings. A craniotomy was performed and because of excessive bleeding only biopsies could be taken. An infantile capillary hemangioma was diagnosed histopathologically. It showed an increase in size and compression of the optic nerve in the first month of life. Therefor he was treated with prednisone 2mg/kg/d for 6 weeks and the hemangioma regressed significantly.

Patient 2 is a 14 month old girl which presented at the age of 3 month with proptosis left. cMRI revealed a tumour of the left orbita with compression of the left bulb and excavation of the orbital wall. Histopathologically a capillary hemangioma was diagnosed. A therapy with prednisone 2mg/kg/d was initiated and showed a rapid regression of the hemangioma.

Conclusion: Capillary intracranial hemangioma are rare and difficult to treat with surgery because of a high risk of hemorrhagic complications. Corticosteroids are a potent alternative therapy of intracranial capillary hemangiomas. The risk of corticoid related side effects, especially hyperglykemia, high blood pressure or cardiomyopathy make regular follow-ups mandatory.