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Published on: July 5, 2021
Cavernous sinus haemangioma: systematic review and pooled analysis relating to a rare skull base pathology
Temidayo Osunronbi1,2, Pinky May Myat Noe Pwint3, John Usuah4
1Department of Surgery, Hull University Teaching Hospital, Hull, UK.
Insights
Cavernous sinus haemangiomas (CSHs) are rare vascular malformations. Radiosurgery offers superior outcomes for CSH treatment, significantly improving symptom resolution and reducing complications compared to surgery alone.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Cavernous sinus haemangiomas (CSHs) are uncommon vascular malformations originating in the cavernous sinus.
- Headaches and diplopia are the most frequent presenting symptoms.
Purpose of the Study:
- To conduct a systematic review and pooled data analysis of clinical features, diagnostics, management, and outcomes of CSHs.
- To compare the efficacy of different treatment modalities for CSHs.
Main Methods:
- Systematic review of 68 articles encompassing 338 CSH cases.
- Pooled data analysis using binary logistic regression to assess outcomes.
- Dynamic contrast-enhanced MRI identified as the most definitive diagnostic imaging modality.
Main Results:
- Dynamic contrast-enhanced MRI demonstrated 89.5% sensitivity for CSH diagnosis.
- Radiosurgery (47.9%) was the most common treatment, followed by surgical resection (37.9%).
- Radiosurgery alone yielded significantly better symptom resolution and fewer complications than surgery alone.
Conclusions:
- Radiosurgery provides superior outcomes for cavernous sinus haemangiomas regarding symptom improvement and complication reduction.
- Combined therapy also reduced complication risks compared to surgery alone.
- Radiosurgery emerges as the preferred treatment for CSHs.
Abstract:
Cavernous sinus haemangiomas (CSHs) are rare malformations of the microcirculation arising from the cavernous sinus. A systematic review and pooled data analysis of the associated clinical features, diagnostic modalities, management, and outcomes for CSHs was done. In total, 68 articles (338 cases) were eligible for analysis based on our selection criteria. The primary outcome measures were the occurrence of (i) and (ii) symptom resolution/improvement. Categorical outcome variables were assessed by binary logistic regression at 5% significance level. With headaches (39.9%) and diplopia (36.5%) as the most common presenting symptoms reported, dynamic contrast-enhanced MRI was the most commonly used diagnostic modality and was the most definitive pre-treatment imaging modality for diagnosing CSH with a sensitivity of 89.5%. The majority of CSHs were managed with radiosurgery (47.9% of cases), 37.9% by surgical resection alone, and 14.2% by a combination of both. Compared to patients that were treated with surgical resection only, those treated solely with radiosurgery had a 100% decrease in the odds of developing post-treatment complications (adjusted OR: 0.00, 95% CI: 0.00-0.002, p < 0.001), with a 5.03 times greater odds of symptom resolution/improvement (adjusted OR: 5.03, 95% CI: 1.89-13.4, p = 0.001). Patients that underwent combined therapy had a 79% reduction in risk of developing post-treatment complications (adjusted OR: 0.21, 95% CI: 0.06-0.68, p = 0.01), with no statistically significant difference in the odds of symptom resolution/improvement, compared to those that had surgery only. In conclusion, radiosurgery offered the best outcomes with regards to symptom resolution/improvement and post-treatment complications in patients with CSH.
