Gamma Knife surgery for a hemangioma of the cavernous sinus in an adult: Case report and short review of the literature

Neurochirurgie. 2017 Sep;63(4):320-322. doi: 10.1016/j.neuchi.2017.05.001. Epub 2017 Sep 4.

Abstract

Cavernous sinus hemangiomas (CSH) are rare benign extra-axial vascular lesions. Both radiological and clinical aspects are important, for deciding a therapeutic modality, including medical treatment, radiation therapy or microsurgery. In the particular case of CSH, a radical removal of the tumor often cannot be achieved and is associated with a considerable risk for intraoperative uncontrollable bleeding. An alternative treatment modality is radiosurgery. Here we report the case of a 45-year-old patient, who presented with diplopia due to left abducens nerve palsy. A left-sided cavernous sinus lesion was found, initially considered to be a meningioma. However, after serial MR acquisitions, a progressive and heterogeneous enhancement was observed. In order to clarify the diagnosis between meningioma and hemangioma, a diagnostic Tc-99m labeled red blood cells (RBC) scintigraphy (Tc-99m RBC scintigraphy) was performed and showed a typical perfusion blood pool mismatch, with accumulation of the RBC at the level of the left CS, which is typical for a hemangioma. The patient underwent Gamma Knife surgery. The CSH showed a significant reduction in size starting 6 months after treatment and a full regression of the left abducens nerve palsy was observed within 1 year. These clinical and radiological results persisted over the next 3 years.

Keywords: Cavernous sinus; Gamma Knife; Hemangioma; Radiosurgery.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / therapy*
  • Cavernous Sinus / diagnostic imaging
  • Cavernous Sinus / surgery*
  • Hemangioma / diagnostic imaging
  • Hemangioma / therapy*
  • Humans
  • Middle Aged
  • Radiosurgery*