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Cavernous Hemangioma of the Cavernous Sinus
from: Tansu MERTOL, Nurullah YÜCEER Department of Neurosurgery, School of Medicine, University of Dokuz Eylül, Izmir, Turkey.A case with giant cavernous hemangioma in the cavernous sinus is reported. The patient had a 5-month history of headache and visual symptoms. Computerized tomography (CT) and magnetic resonance imaging (MRI) studies demonstrated a lesion of the cavernous sinus in the left middle fossa. Only a biopsy of the cavernous malformation of cavernous sinus was performed during the first surgery because of uncontrollable haemorrhage during surgery. After the operation, radiation therapy was performed. Five years later, the lesion was totally removed because of its gradual enlargement. The second surgery was uncomplicated except for partial third nerve palsy. Ten years after the operation, the patient was in good health and there was no recurrence of the cavernous angioma.
Cerebral vascular malformations are classified as arteriovenous malformation, venous angioma, cavernous malformation and capillary telengiectasia(22). Cavernous malformations make up of 5 to 10% of all central nervous system vascular malformations (22, 25). Intracranial cavernous malformations may be intracerebral or extracerebral. Cerebral cavernous A B malformations frequently occur in the sylvian fissure and brain stem (11, 22, 25, and 30).
Intracranial extracerebral cavernous malformations (ECCMs) are rare vascular malformations. ECCMs make up approximately 1% of intracranial cavernous malformations (2, 4, 34). The most common localization for ECCMs is the middle cranial fossa (8,13,14,17,19,24,33).
Treatment of middle cranial fossa cavernous malformations is difficult when compared with cerebral cavernous malformations and has high morbidity and mortality due to surgical complications.
In this study, we report a case with cavernous malformation in the cavernous sinus, mimicking a meningioma. The case is interesting because giant cavernous malformations of the cavernous sinus are rare. Cavernous malformations may grow up progressively in spite of radiation therapy. Treatment of growing cavernous sinus cavernous malformations is surgical removal.
CASE REPORT First admission
A 33-year-old man was admitted with a 5-month history of headache and double vision. His neurological examination confirmed ptosis of the left eye and coulometer paresis. The left pupil was dilated. A CT scan with contrast enhancement showed a hyperdense lesion located in the cavernous sinus (Figures 1A, 1B). MR scans demonstrated a 2x2x2 cm homogeneously enhancing tumour which filled the left cavernous sinus, mimicking a meningioma or a cavernous angioma (Figures 1C, 1D).
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