Radiosurgery for hemangiomas of the cavernous sinus and orbit: technical case report

Hemangiomas of neurosurgical interest are histologically benign vascular tumors that most often occur in the orbit or cavernous sinus. Hemangiomas can be diagnosed by their characteristic radiographic and angiographic appearance and their tendency to bleed excessively during attempted removal. Intracranial or intraorbital hemangiomas require treatment when they become symptomatic.

We report four hemangioma patients who presented with ocular symptoms or signs, such as orbital pain, ophthalmoplegia, proptosis, or impaired visual acuity. Before our evaluation, two patients had each had incomplete resections aborted because of excessive blood loss, one patient had undergone a nondiagnostic transsphenoidal biopsy, and one patient had had an unsuccessful embolization.

All four patients were treated with gamma knife radiosurgery. Tumors received a minimal tumor dose that ranged from 14 to 19 Gy. Follow-up evaluations were performed 6 to 24 months after radiosurgery and revealed a reduction in tumor volume in three patients and no tumor progression in the fourth. All patients had symptomatic improvement, but one had persistent diplopia.

In this early experience, stereotactic radiosurgery proved to be an effective management strategy that avoided the potentially serious complications associated with surgery or embolization of cavernous sinus hemangiomas.