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Cavernous sinus hemangiomas: a series, a review, and an hypothesis
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Neurosurgery
|January 1, 1992
Summary
Cavernous sinus hemangiomas, though risky due to bleeding, are safely resectable with a pseudocapsule. Surgical techniques ensure minimal blood loss and preserve cranial nerve function, aiding diagnosis via MRI.
Area of Science:
- Neurosurgery
- Neuroradiology
- Oncology
Background:
- Cavernous sinus hemangiomas constitute 3% of benign cavernous sinus tumors.
- These vascular tumors pose significant bleeding risks but are distinct from meningiomas due to a pseudocapsule facilitating dissection.
Observation:
- Hemangiomas exhibit marked hyperintensity on T2-weighted MRI, aiding preoperative differentiation from meningiomas.
- Tumors originate within the cavernous sinus, extending laterally and dissecting dural layers.
- Cranial nerves III, IV, and V are stretched externally, while cranial nerve VI is embedded within the tumor, posing preservation challenges.
Findings:
- Total excision with minimal blood loss and no stroke was achieved in three reported cases.
- Cranial nerve function was preserved in two of the three cases.
- A review of 50 literature cases and surgical principles for safe excision are presented.
Implications:
- Preoperative assessment of carotid artery occlusion safety and early proximal control are crucial for surgical success.
- Careful dissection along the tumor's pseudocapsule, early devascularization, and avoiding piecemeal resection are key principles.
- Radiation therapy can be considered for incomplete excision or medically unfit patients, potentially inducing tumor shrinkage.