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Resection of a Large Cavernous Hemangioma Following Preoperative Embolization in a Child's Temporal Bone
Yosaku Torii1, Makoto Hosoya1, Natsuki Hasebe1
1Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Insights
Primary intraosseous cavernous hemangiomas (PICHs) are rare in children. This case highlights successful embolization and resection of a temporal bone PICH in an 11-year-old girl.
Area of Science:
- Otolaryngology
- Pediatric Neurosurgery
- Vascular Malformations
Background:
- Primary intraosseous cavernous hemangiomas (PICHs) are rare vascular tumors.
- PICHs of the temporal bone are exceptionally uncommon, especially in pediatric patients.
- Surgical management is challenging due to potential for significant hemorrhage.
Observation:
- An 11-year-old girl presented with hearing loss, aural fullness, and otalgia.
- Initial imaging suggested lymphoma, but biopsy revealed extensive arterial bleeding.
- Angiography identified the middle meningeal artery as the main feeding vessel.
Findings:
- A large PICH in the temporal bone was diagnosed.
- Preoperative embolization of the middle meningeal artery was performed.
- Successful surgical resection of the temporal bone PICH was achieved.
Implications:
- This case demonstrates the feasibility and efficacy of preoperative embolization for pediatric temporal bone PICHs.
- Embolization can mitigate intraoperative bleeding risks in these rare pediatric cases.
- Highlights the importance of considering vascular malformations in pediatric temporal bone lesions.
Abstract:
Primary intraosseous cavernous hemangiomas (PICHs) in the temporal bone are very rare. Most treated cases are in adult patients, and there are very few reports involving children. To our knowledge, no cases reported have ever actually adopted embolization in children, although several reports recommend preoperative embolization of the feeding arteries. Here, we present a case of a child with a large cavernous hemangioma developing in the temporal bone. The patient was an 11-year-old girl whose chief complaints were hearing loss, aural fullness, and otalgia. Based on imaging, a lymphoma was initially suspected, but extensive arterial bleeding occurred during biopsy under local anesthesia. Angiography was performed to evaluate the blood flow in the tumor, and revealed the middle meningeal artery as a main feeding artery to the tumor. A huge PICH at the temporal bone was successfully resected following preoperative embolization of the feeding artery.
