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Cavernous sinus hemangioma. Clinical and neuroimaging features
A G Lee1, N R Miller, P W Brazis
1Neuro-ophthalmology Unit, Wilmer Ophthalmological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Summary
Cavernous sinus hemangiomas can mimic meningiomas on imaging, presenting as isolated sixth nerve palsy. Biopsy confirmed hemangioma, highlighting the need to consider vascular lesions in the differential diagnosis.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- The cavernous sinus is a complex venous structure at the base of the skull housing important cranial nerves and vasculature.
- Lesions within the cavernous sinus can present with diverse clinical manifestations, often related to cranial nerve dysfunction.
- Differentiating between various pathologies in the cavernous sinus is crucial for appropriate management.
Observation:
- A patient presented with isolated left sixth nerve palsy, indicative of cranial nerve dysfunction.
- Neuroimaging revealed a 3 cm, sharply marginated lesion in the left cavernous sinus with characteristic MRI signal intensities and contrast enhancement.
- Cerebral angiography demonstrated a homogeneous vascular blush supplied by an enlarged meningohypophyseal artery.
Findings:
- Initial neuroimaging findings suggested a cavernous sinus meningioma.
- Intraoperative findings revealed a vascular mass.
- Histopathological examination of the biopsy confirmed the diagnosis of cavernous hemangioma.
Implications:
- Cavernous sinus hemangiomas can present with imaging features that overlap with other lesions, such as meningiomas.
- Accurate differentiation of cavernous sinus hemangiomas is essential for guiding surgical or interventional treatment strategies.
- This case underscores the importance of considering vascular malformations in the differential diagnosis of cavernous sinus masses presenting with cranial nerve palsies.