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Congenital Calvarial Hemangioma
Michal Brichacek1, Abdul Naeem2, Guido Filler3
1Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba.
Insights
Congenital calvarial hemangioma, a rare skull lesion, can be effectively treated with propranolol therapy. This case study highlights propranolol as a viable alternative to surgery for managing this condition.
Area of Science:
- Pediatric Neurosurgery
- Vascular Anomalies
- Pharmacological Treatment
Background:
- Congenital calvarial hemangiomas are rare vascular tumors of the skull.
- Diagnosis typically involves imaging and biopsy.
- Surgical resection has been the traditional treatment.
Observation:
- A 2-year-old boy presented with a growing parietal skull mass.
- Imaging revealed a benign-appearing lesion with characteristic trabeculations.
- Histopathology confirmed a cavernous hemangioma.
Findings:
- Propranolol therapy was administered for over three years.
- The hemangioma showed a significant reduction in size during treatment.
- MRI confirmed mass reduction post-propranolol therapy.
Implications:
- Propranolol offers a non-surgical treatment option for congenital calvarial hemangioma.
- This approach may be suitable for select cases, avoiding surgical risks.
- Early consideration of propranolol is important for managing skull lesions.
Objectives:
The authors describe a case of congenital calvarial hemangioma successfully managed using propranolol therapy. Presenting symptoms, radiological and pathological features, differential diagnosis, and management of this rare congenital mass are described.
Case Presentation:
A 2-year-old boy presented with a 1-year history of a growing right parietal skull mass. No obvious etiology was apparent. No focal neurological deficits or associated craniofacial anomalies were identified. Plain film imaging demonstrated focal thickening of the right parietal bone with internal trabeculations in a sunburst appearance. Computed tomography (CT) scan showed bone thickening with coarsening of the bony trabeculae, minor irregularity of the outer table, unaffected inner table, and no evidence of aggressive features. A diagnostic biopsy of the lesion was performed in the operating room. Microscopic examination was consistent with hemangioma. Based on histological and radiological features of the lesion, it was identified as a cavernous hemangioma. Medical treatment utilizing propranolol was initiated for over 3 years with interval reduction in the lesion size. MRI head following treatment with propranolol demonstrated reduction of the mass compared to preoperative imaging.
Conclusions:
Although a rare entity, it is important to consider congenital calvarial hemangioma in the differential diagnosis of slow growing skull lesions due to the possibility of complications as a result of the hemangioma's intracranial extension, and the potential for treatment. En bloc resection has classically been described as a treatment for such lesions, although our case demonstrates that medical treatment with propranolol therapy may be appropriate in certain situations.
