Multimodality Management of Cavernous Sinus Hemangiomas—An Institutional Experience

Abstract

Objective Cavernous sinus hemangiomas (CSHs) are benign lesions accounting for less than 2% of the cavernous sinus tumors. They provide a formidable surgical challenge because of their vascularity and their being surrounded by critical neurovascular structures. In this study, one of the largest in available literature, we analyze our experience in the management of these unusual tumors and review the available literature.

Materials This is a retrospective analysis of patients who were managed surgically (both microsurgical and Gamma knife radiosurgery [GKRS]) for CSH at our Institution from 2007 to 2015. Complete demographic, clinical-radiologic surgical records were analyzed. Follow-up data were collected from the hospital records.

Results Total 23 patients were managed. Among these, 15 patients underwent microsurgery (group 1) whereas 8 underwent GKRS (group 2). Predominant clinical presentation in both the groups included headache and involvement of multiple cranial nerves. Five patients in group 1 had deteriorating vision. The volume of tumors ranged from 29 to 115 cm³ (mean = 64.57 cm³) in group 1 and from 2.1 to 11.6 cm³ in group 2. GKRS was performed with a mean dose of 13 Gy, an average isodose line of 50% with an average coverage of 96%. In group 1, the follow-up period ranged from 6 to 62 months (mean = 29.4 months). The extraocular movement (EOM) preservation rate in our series was not favorable, as most patients presented late with large tumors and established deficits. Recurrence/residual tumor was seen in two cases. In group 2, the follow-up was 5 to 48 months. All of them showed significant reduction in size.

Conclusion Both surgery and radiosurgery are highly effective in the management of CSHs. They are complementary to each other, with individual characteristics—the size and volume of the lesion—being the main factors in deciding the choice of treatment.

Keywords

hemangiomas - cavernous sinus - Gamma knife radiosurgery - interdural approach

Source of Support

Nil.

• References

• 1 Gonzalez LF, Lekovic GP, Eschbacher J, Coons S, Porter RW, Spetzler RF. Are cavernous sinus hemangiomas and cavernous malformations different entities?. Neurosurg Focus 2006; 21 (01) e6
• 2 Linskey ME, Sekhar LN. Cavernous sinus hemangiomas: a series, a review, and an hypothesis. Neurosurgery 1992; 30 (01) 101-108
• 3 Al-Mefty O, Smith RR. Surgery of tumors invading the cavernous sinus. Surg Neurol 1988; 30 (05) 370-381
• 4 Dolenc VV. Transcranial epidural approach to pituitary tumors extending beyond the sella. Neurosurgery 1997; 41 (03) 542-550 , discussion 551–552
• 5 Dolenc VV. Extradural approach to intracavernous ICA aneurysms. Acta Neurochir Suppl (Wien) 1999; 72: 99-106
• 6 Goel A. The extradural approach to lesions involving the cavernous sinus. Br J Neurosurg 1997; 11 (02) 134-138
• 7 Iwai Y, Yamanaka K, Nakajima H, Yasui T. Stereotactic radiosurgery for cavernous sinus cavernous hemangioma—case report. Neurol Med Chir (Tokyo) 1999; 39 (04) 288-290
• 8 Namba S. Extracerebral cavernous hemangioma of the middle cranial fossa. Surg Neurol 1983; 19 (04) 379-388
• 9 Meyer FB, Lombardi D, Scheithauer B, Nichols DA. Extra-axial cavernous hemangiomas involving the dural sinuses. J Neurosurg 1990; 73 (02) 187-192
• 10 Peker S, Kiliç T, Sengöz M, Pamir MN. Radiosurgical treatment of cavernous sinus cavernous haemangiomas. Acta Neurochir (Wien) 2004; 146 (04) 337-341 , discussion 340
• 11 Biondi A, Clemenceau S, Dormont D. , et al. Intracranial extra-axial cavernous (HEM) angiomas: tumors or vascular malformations?. J Neuroradiol 2002; 29 (02) 91-104
• 12 Janjua RM, Al-Mefty O, Densler DW, Shields CB. Dural relationships of Meckel cave and lateral wall of the cavernous sinus. Neurosurg Focus 2008; 25 (06) E2
• 13 Eisenberg MB, Al-Mefty O, DeMonte F, Burson GT. Benign nonmeningeal tumors of the cavernous sinus. Neurosurgery 1999; 44 (05) 949-954 , discussion 954–955
• 14 Momoshima S, Shiga H, Yuasa Y, Higuchi N, Kawase T, Toya S. MR findings in extracerebral cavernous angiomas of the middle cranial fossa: report of two cases and review of the literature. AJNR Am J Neuroradiol 1991; 12 (04) 756-760
• 15 Bansal S, Suri A, Singh M. , et al. Cavernous sinus hemangioma: a fourteen year single institution experience. J Clin Neurosci 2014; 21 (06) 968-974
• 16 Yin YH, Yu XG, Xu BN, Zhou DB, Bu B, Chen XL. Surgical management of large and giant cavernous sinus hemangiomas. J Clin Neurosci 2013; 20 (01) 128-133
• 17 Zhou LF, Mao Y, Chen L. Diagnosis and surgical treatment of cavernous sinus hemangiomas: an experience of 20 cases. Surg Neurol 2003; 60 (01) 31-36 , discussion 36–37
• 18 Gliemroth J, Missler U, Sepehrnia A. Cavernous angioma as a rare neuroradiologic finding in the cavernous sinus. J Clin Neurosci 2000; 7 (06) 554-557
• 19 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 (06) 1148-1151
• 20 Shi J, Hang C, Pan Y, Liu C, Zhang Z. Cavernous hemangiomas in the cavernous sinus. Neurosurgery 1999; 45 (06) 1308-1313 , discussion 1313–1314
• 21 Yamamoto M, Kida Y, Fukuoka S. , et al. Gamma knife radiosurgery for hemangiomas of the cavernous sinus: a seven-institute study in Japan. J Neurosurg 2010; 112 (04) 772-779
• 22 Suzuki Y, Shibuya M, Baskaya MK. , et al. Extracerebral cavernous angiomas of the cavernous sinus in the middle fossa. Surg Neurol 1996; 45 (02) 123-132
• 23 Nakamura N, Shin M, Tago M. , et al. Gamma knife radiosurgery for cavernous hemangiomas in the cavernous sinus. Report of three cases. J Neurosurg 2002; 97 (5, Suppl) 477-480