Cavernous Sinus Hemangioma: Imaging Diagnosis and Surgical Considerations

World Neurosurg. 2021 Feb;146:e30-e37. doi: 10.1016/j.wneu.2020.09.153. Epub 2020 Oct 5.

Abstract

Background: Cavernous sinus hemangiomas (CSHs) are extraaxial vascular malformations that tend to bleed during surgery.

Methods: We reviewed 12 magnetic resonance imaging scans with CSH, 5 of them biopsy proven.

Results: In our review, CSH commonly presented as a lobulated mass with high, uniform signal intensity on T2-weighted images, a dumbbell shape, and a sellar extension. Two thirds presented a "filling-in" pattern of enhancement on dynamic imaging. These features should lead to a correct preoperative diagnosis, which is essential for surgical planning and avoiding hemorrhagic complications.

Conclusions: A combination of low signal on T1, high signal on T2 and fluid-attenuated inversion recovery, no diffusion restriction and homogenous enhancement should place CSH at the top of the list of differential diagnoses. This is especially true when there is a "filling-in" pattern on dynamic or delayed imaging. Doing so may alert surgeons to the possibility of copious intraoperative bleeding and therefore avoid complications of hemorrhage.

Keywords: Cavernous angiomas; Cavernous sinus hemangioma; Dynamic-enhanced MRI; Venous malformations.

MeSH terms

  • Adult
  • Cavernous Sinus / pathology
  • Cavernous Sinus / surgery*
  • Diagnosis, Differential
  • Diagnostic Tests, Routine
  • Female
  • Hemangioma, Cavernous / pathology*
  • Hemangioma, Cavernous / surgery*
  • Hemangioma, Cavernous, Central Nervous System / pathology*
  • Hemangioma, Cavernous, Central Nervous System / surgery*
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Paranasal Sinuses / pathology
  • Paranasal Sinuses / surgery