Diagnosis and microsurgical treatment of cavernous sinus hemangioma

To investigate the diagnosis and microsurgical treatment of cavernous sinus hemangioma, the clinical data, including pathology, epidemiology, medical imaging, operation procedure, and post-operational complication of 12 cavernous sinus hemangioma patients undergoing operations in Affiliated Hospital of Medical College of Qingdao University from 1999 to 2008, were analyzed. There were 2 males and 10 females. The patients were aged from 28 to 61 years. Headaches and deficits of the cranial nerves coursing through the cavernous sinus were the principal symptoms at presentation. The common clinical manifestations were visual loss, diplopia, facial numbness, and extraocular muscle palsy. The radiological features in all patients were similar with a characteristic pattern of extension and encasement of carotid artery. CT showed the lesion as hypodense to isodense with marked enhancement after contrast administration. T1-weighted MR imaging showed the lesions as hypointense with marked enhancement after contrast administration. T2-weighted MR imaging showed the lesions as hyperintense. The maximum size of the lesion was 9 to 57 mm (mean 45 mm). Basal pterional craniotomies were used for eight patients. Orbitozygomatic osteotomies were used for two patients. Pterional approach was used for two patients. The lesions were removed through incising the lateral wall of the cavernous sinus. The tumor was totally removed in five cases, subtotally removed in four cases, and partially removed in two cases. The main post-operational complications included oculomotor nerve paralysis (four cases) and trigeminal nerve lesions (three cases). No postoperative death occurred. Operation is the best choice for cavernous sinous hemangioma. It was helpful to control bleeding through intradura and incising the lateral wall of the cavernous sinus.