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Huo R, Yu Q, Xu H, Wang J, Zhao S, Weng J, Bai X, Jiao Y, Zhang W, He Q, Wu Z, Liu S, Sun Y, Ni Y, Tang J, Wang S, Cao Y. Progression of the Residual Lesion in Cavernous Sinus Extra-Axial Cavernous Hemangioma After Surgery. Transl Stroke Res 2025:10.1007/s12975-025-01333-5. [PMID: 39888576 DOI: 10.1007/s12975-025-01333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 01/06/2025] [Accepted: 01/22/2025] [Indexed: 02/01/2025]
Abstract
Our study aimed to investigate the factors associated with residual cavernous sinus extra-axial cavernous hemangiomas (ECHs) progression after surgery. This retrospective study consecutively included patients of cavernous sinus ECHs with incomplete lesion resection from February 2012 to January 2024. The progression of the lesions was defined as new lesions or a growth of residual lesion (≥ 10% increase in volume). Cox regression analysis was used to determine factors associated with residual lesion progression. Kaplan-Meier analysis was conducted to estimate the cumulative incidence of residual lesion progression. Sixty patients were included in this study. During the follow-up, there were 31 (51.7%) residual lesions underwent progression, whereas 29 (48.3%) patients were nonprogressive. Multivariate Cox analysis showed that the homogeneous enhancement lesion was correlated with the residual lesion progression (HR, 8.17 [95% CI, 1.03-64.58]; p = 0.046). Kaplan-Meier survival analysis indicated that the rate of homogeneous enhancement lesion progression (3.7 per 10 person-years) was significantly higher than that of the heterogeneous enhancement group (0.5 per 10 person-years; p = 0.019). Fourteen of the 31 patients with lesion progression underwent radiotherapy, and all of them experienced control over the progression of their lesions. This study found that end-of-treatment residual lesions are not rare in patients with cavernous sinus ECHs and the MRI feature is helpful to predict the progression of residual lesions.
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Affiliation(s)
- Ran Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qifeng Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyuan Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jie Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shaozhi Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiancong Weng
- Department of Neurosurgery, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiudan Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuming Jiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wenqian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhiyou Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shaowen Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yingfan Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yang Ni
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinyi Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road West, Beijing, 100070, Fengtai District, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
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Demir MK, Kılıc D, Zorlu E, Kılıc T. Giant Intracranial Cavernous Malformations: A Review on Magnetic Resonance Imaging Characteristics. Indian J Radiol Imaging 2024; 34:511-521. [PMID: 38912256 PMCID: PMC11188748 DOI: 10.1055/s-0044-1779587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background Intracranial cavernous malformations (CMs), commonly known as cavernomas or cavernous angiomas, are low-flow, well-circumscribed vascular lesions composed of sinusoidal spaces lined by a single layer of endothelium and separated by a collagenous matrix without elastin, smooth muscle, or other vascular wall elements. A diameter greater than 3 cm for a CM is unlikely. These lesions may have atypical appearances on magnetic resonance imaging (MRI). MRI with advanced techniques such as a susceptibility-weighted image or T2-gradient echo, a diffusion-weighted image and corresponding apparent diffusion coefficient map, and diffusion tensor tractography have revolutionized the diagnostic approach to these lesions. Materials and Method The present study reviews the etiopathogenesis, clinical manifestations, MRI strategy, and MRI appearances of the CMs, with a few examples of the giant CMs from our archive. Results Intracranial giant CMs may have unexpected locations, sizes, numbers, and varied imaging appearances due to repeated hemorrhages, unusual enhancement patterns, intense perifocal edema, and unusual associations, making the differential diagnosis difficult. Conclusion Familiarity with the MRI appearances of the giant intracranial CMs and the differential diagnosis improves diagnostic accuracy and patient management.
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Affiliation(s)
- Mustafa Kemal Demir
- Clinic of Radiology, Bahcesehir University Goztepe Medical Park Hospital, Istanbul, Turkey
| | - Deniz Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Emre Zorlu
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Turker Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
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Helmy M, Liao Y, Zhang Y, He K. The Treatment Outcomes of Radiotherapy and Surgical Treatment for Patients with Cavernous Sinus Hemangioma: A Meta-Analysis. World Neurosurg 2023; 178:e345-e354. [PMID: 37480987 DOI: 10.1016/j.wneu.2023.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE Cavernous sinus hemangiomas (CSHs) are infrequent benign neoplasms. This meta-analysis was conducted with the objective of examining the prognostic outcomes of surgical interventions and radiotherapy (RT) in patients diagnosed with CSHs. METHODS A comprehensive literature search was performed across PubMed, Embase, and Web of Science databases, with traceability up to June 22, 2021. The evaluation of continuous variables was conducted by applying the weighted mean difference (WMD) and 95% confidence interval. A one-arm meta-analysis was used to scrutinize the tumor control rate, clinical improvement rate, recovery rates of abducens nerve palsy and visual disturbance, total resection rate, and the incidence rate of permanent nerve palsy post-treatment. RESULTS In total, 29 articles were incorporated into the meta-analysis. Post-RT for CSHs, a significant reduction in tumor volume was observed (WMD [95% confidence interval] = -17.16 [-21.52, -12.80] cm3). The tumor control rate, clinical improvement rate, recovery rate of abducens nerve palsy, and the recovery rate of visual disturbance were 97.1% (92.9, 99.7), 91.9% (82.3, 98.5), 95.6% (83.2, 100.0), and 86.3% (65.0, 99.5), respectively. Following surgical treatment, the total resection rate, mean intraoperative blood loss, recovery rate of visual disturbance, incidence rate of permanent nerve palsy, and recovery rate of abducens nerve palsy were 73.2% (57.1, 86.9), 971.17 mL (584.07, 1358.27), 66.4% (32.4, 0.942), 16.0% (4.6, 31.1), and 70.6% (51.0, 87.7), respectively. Notably, the recovery rate of abducens nerve palsy post-RT was markedly higher than postsurgical treatment. CONCLUSIONS The results of this meta-analysis underscore that RT is an effective and safe treatment modality for CSHs. Furthermore, the prognostic outcomes of RT demonstrated superiority over surgical intervention.
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Affiliation(s)
- Mohamed Helmy
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Yujun Liao
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - YiYin Zhang
- Department of Nursing, Fudan University Huashan Hospital, Shanghai, China
| | - Kangmin He
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
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Yang R, Xv Z, Zhao P, Li J, An Q, Huang S, Wang X. Personalized Gamma Knife radiosurgery for cavernous sinus hemangiomas: A Chinese single-center retrospective study for 10 years of 187 patients. Neurooncol Pract 2022; 9:545-551. [DOI: 10.1093/nop/npac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The aim of this study is to retrospectively review the effectiveness and safety of personalized Gamma Knife radiosurgery (GKRS) for cavernous sinus hemangiomas (CSHs) and to summarize experience of personalized GKRS treatment for different volume of CSHs.
Methods
187 CSHs patients who received personalized GKRS treatment in our center from January 1, 2011 to December 31, 2020 were enrolled in this study and classified into small and medium CSHs (<20 ml), large CSHs (20–40 ml) and giant CSHs (≥40 ml) according to tumor volume. The personalized GKRS treatment strategy included single GKRS and staged GKRS. Tumor shrinkage rate, clinical symptoms response, and complications after GKRS were recorded during the follow-up period. Multivariate factors influencing clinical symptoms response were analyzed after personalized GKRS treatment.
Results
After a mean follow-up duration of 28 months (range 12–124 months), the tumor control rate was 100%, and the mean shrinkage rate of CSHs was 93.2% (61.3%–100%) in the last follow-up. Of the 115 patients with preexisting symptoms, 43 (37.5%) patients showed symptom disappearance, 17 (14.7%) patients demonstrated improvement, and 55 (47.8%) patients remained with no change. Previous surgical resection of CSHs (OR = 0.025, 95% CI 0.007–0.084, P = .000) was identified to be an independent risk factor for no symptom improvement after GKRS treatment.
Conclusions
Personalized GKRS is an effective and safe treatment for different volume of CSHs, which is capable of shrinking the tumor and improving symptoms with extremely low incidence of adverse effects and might be considered as the primary treatment strategy for CSHs.
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Affiliation(s)
- Ruyi Yang
- Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
| | - Ziqiang Xv
- Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
| | - Puxue Zhao
- Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
| | - Junwu Li
- Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
| | - Quan An
- Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
| | - Shan Huang
- Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
| | - Xinjun Wang
- Department of Neurosurgery, The Third Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan 450052 , PR China
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Less common extracerebral tumors. PROGRESS IN BRAIN RESEARCH 2022; 268:279-302. [PMID: 35074086 DOI: 10.1016/bs.pbr.2021.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This chapter examines the results of GKNS on a variety of extraparenchymal skull base tumors some benign and some malignant. For the benign tumors there is good evidence on the effectiveness of the method for pretty much all diagnoses. For malignant extraparenchymal tumors the results are more limited and GKNS only has a supportive role in these lesions.
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Yang R, Wang X, Xv Z, Zhao P, Li J, An Q, Huang S. Long-term outcomes of staged Gamma Knife radiosurgery for giant cavernous sinus hemangiomas: a single-center retrospective study. J Neurosurg 2021:1-7. [PMID: 34715663 DOI: 10.3171/2021.7.jns21955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cavernous sinus hemangiomas (CSHs) are rare benign tumors originating from the cavernous sinus. Gamma Knife radiosurgery (GKRS) has been recommended as a primary treatment for small- to medium-sized CSHs. The optimal treatment for giant CSHs is still controversial. In this study, the authors retrospectively reviewed the effectiveness and safety of staged GKRS treatment for giant CSHs. METHODS Twenty-two patients with giant CSH who received staged GKRS treatment in the Gamma Knife Treatment Center of Henan Province during the period from January 1, 2011, to December 31, 2018, were enrolled in this study. Six patients had received microsurgery before GKRS, the other 16 patients were diagnosed according to clinical symptoms and MR images. All of the enrolled patients received 2-stage GKRS, and the mean interval between the two GKRS treatments was 6.5 months (range 6-12 months). For the first GKRS, the median isodose line was 48% (range 45%-50%), the median marginal dose was 13 Gy (range 11.5-14 Gy), and the median coverage of CSHs was 80% (range 70%-88%). For the second GKRS treatment, the median isodose line was 50% (range 45%-55%), the median marginal dose to the CSHs was 10.5 Gy (range 9-12.5 Gy), and the median coverage of the CSHs was 88% (range 80%-94%). RESULTS All of the patients received an outpatient review of an enhanced MR image of the head and a clinical physical check every 6 months after the first GKRS treatment. The mean follow-up duration was 52 months (range 24-84 months). The tumor control rate was 100% 24 months after staged GKRS, and at the last follow-up the mean tumor shrinkage rate was 96.7% (range 90.6%-100%) and the mean residual CSH volume was 2.1 ml (range 0-8.5 ml). Twenty patients suffered central nervous system (CNS) injury symptoms to varying degrees before staged GKRS treatment. Complete symptom recovery was found in 11 (55%) patients, improved symptoms in 5 (25%) patients, and no change in 4 (20%) patients after treatment. Only 1 patient suffered temporary preexisting headache aggravation and 1 patient suffered temporary preexisting diplopia aggravation 1 week after receiving the first GKRS treatment. Subacute or chronic complications were not detected after staged GKRS. CONCLUSIONS Staged GKRS is an effective treatment for giant CSHs. Because of the impressively low incidence of adverse effects, staged GKRS may be considered as a primary treatment for giant CSHs.
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Affiliation(s)
- Ruyi Yang
- 1Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University, and.,2Department of Neurosurgery, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xinjun Wang
- 1Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University, and.,2Department of Neurosurgery, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ziqiang Xv
- 1Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University, and
| | - Puxue Zhao
- 1Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University, and
| | - Junwu Li
- 1Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University, and
| | - Quan An
- 1Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University, and
| | - Shan Huang
- 1Gamma Knife Treatment Center of Henan Province, Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University, and
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Repeat gamma knife radiosurgery for cavernous sinus hemangiomas: A report of 3 cases. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
RATIONALE Intrasellar cavernous hemangiomas (ICHs) are rare vascular lesions that arise in the sellar region. ICHs are usually misdiagnosed and treated as pituitary adenomas. Therefore, a preoperative diagnosis is particularly important, especially when the goal is complete resection. PATIENT CONCERNS A 55-year-old woman presented with a 1-month history of intermittent dizziness. Magnetic resonance imaging (MRI) revealed a well-demarcated abnormal ellipsoid signal in the sellar region (size: 2.7 cm × 1.7 cm), with a mulberry-like enhancement after gadolinium injection. Computed tomography revealed an intrasellar mass without calcification that extended into the left cavernous sinus and was faintly contrast-enhanced. Angiography revealed a tumor with mildly delayed staining fed by the C5 segment of the right internal carotid artery. DIAGNOSIS An intrasellar cavernous hemangioma based on neuroradiological examinations. INTERVENTIONS The patient underwent surgery with an endoscopic endonasal transsphenoidal approach to debulk the lesion and obtain tissue for the pathological diagnosis. OUTCOMES Blood spurting was observed after puncture, and the capsule was stained blue. Lesion removal was stopped, and the patient underwent gamma knife surgery 1 week later. She remained in good condition during the follow-up. LESSONS Sponge-like or mulberry-like lesions can be identified on MRI after gadolinium injection and can facilitate a preoperative diagnosis of ICH. Currently, surgical debulking with cranial nerve decompression during the acute stage and subsequent gamma knife radiosurgery are considered to be a safe and effective treatment.
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Affiliation(s)
| | | | | | - Haiyan Lou
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
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Montoya F, Vidal A, Sepulveda F, Marileo R, Caro J, Castillo M. Cavernous Sinus Hemangioma: Imaging Diagnosis and Surgical Considerations. World Neurosurg 2020; 146:e30-e37. [PMID: 33031964 DOI: 10.1016/j.wneu.2020.09.153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022]
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.
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Affiliation(s)
- Francisca Montoya
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile.
| | - Aaron Vidal
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Francisco Sepulveda
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Roberto Marileo
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
| | - Joseline Caro
- Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile
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Xin Z, Yao Y, Chen G, Wang L, Shu M, Lv Q, Yu H, Zhang T. Fractionated Radiation Therapy for Large and Giant Cavernous Sinus Hemangioma: A Retrospective Study. Front Neurol 2020; 11:355. [PMID: 32477242 PMCID: PMC7237578 DOI: 10.3389/fneur.2020.00355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/09/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Surgical resection has been traditionally used as a treatment for cavernous sinus hemangioma (CSH). However, this is usually difficult due to tumor vascularity and results in complications especially in large and giant CSH (volume >20 cm3). Previous studies have reported that radiotherapy (RT) provides an alternative treatment modality for hemangiomas. However, the optimized dose and fractions which control CSH and also protect the cognitive function remain unclear. This study reports our experience in the management of symptomatic large and giant CSH. Methods: Fifty-four patients with symptomatic large (20 cm3 <tumor volume ≤ 40 cm3, 3-4 cm in diameter) and giant (tumor volume>40 cm3, >4 cm in diameter) CSH were enrolled in a retrospective study between January 2007 and December 2018. The prescription dose to the target margin was 50 Gy in 25 fractions. Results: The mean pre-RT tumor volume was 60.9 cm3 which ranged from 20.2 to 230.5 cm3. The clinical data obtained was analyzed retrospectively following a mean follow-up period of 35.0 months which ranged from 1 to 140 months. All patients experienced tumor shrinkage within 3 months after radiotherapy. There was an average mean tumor reduction of 79.7% (range, 48.4-98.5%) with no patients experiencing tumor progression and recurrence. All the 54 patients experienced symptomatic improvement within 1 month to 12 months after radiotherapy. Within the entire follow up period, no patients experienced any form of permanent complications or symptomatic radiation toxicity. Neurocognitive impairment studies were conducted before and after radiotherapy on 28 patients while the studies were conducted after the last follow up in 40 patients. The cognitive function of all the participants had normal MoCA-scores of 28.25 pre-radiotherapy. The post-treatment MoCA-scores were also clinically stable (28.04, p = 0.78), and the average MoCA-score did not show any decline until the last follow-up (27.61, p = 0.13). Conclusion: The optimal dose and fractions of radiotherapy treatment for symptomatic large and giant cavernous sinus hemangioma remain unclear. This study, therefore, used a marginal dose of 50 Gy in 25 fractions in radiotherapy and this was proven to be effective and relatively safe in the treatment of symptomatic large and giant CSHs.
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Affiliation(s)
- Zengfeng Xin
- Department of Radiation Oncology, Zhejiang University School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Department of Orthopedic Surgery, Zhejiang University School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yihan Yao
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
| | - Guodi Chen
- Department of Radiation Oncology, Zhejiang University School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Liancong Wang
- Department of Radiation Oncology, Zhejiang University School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Meibao Shu
- Department of Radiation Oncology, Zhejiang University School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qinghua Lv
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
| | - Haifeng Yu
- Department of Chemotherapy Center, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ting Zhang
- Department of Radiation Oncology, Zhejiang University School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
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Księżniak-Baran D, Blamek S, Roch-Zniszczoł A, Osewski W, Jędrzejewska M. Cavernous sinus haemangioma with intrasellar extension mimicking non-functioning pituitary adenoma - A case report and review of literature. Rep Pract Oncol Radiother 2019; 24:458-461. [PMID: 31406488 DOI: 10.1016/j.rpor.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022] Open
Abstract
Fifty-three-year-old male suffering from a presumptive non-functioning pituitary adenoma was qualified for stereotactic radiosurgery in our institution. Two attempts of surgical treatment were taken three months before radiotherapy. Excessive bleeding did not allow to remove the tumour or to take samples for histopathological examination. Diagnosis was put on the basis of radiological assessment and lack of hypersecretion of pituitary hormones. However, radiological reevaluation in our Institute revealed the presence of a well-bounded tumour invading the cavernous sinus with high contrast enhancement in FLAIR and T2-sequence. Moreover, a constriction of the normal pituitary gland with tumour mass was seen. The imaging features of the lesion finally led to diagnosis of cavernous sinus haemangioma with intrasellar expansion. The patient received radiosurgical treatment with the use of linear accelerator (LINAC). A dose of 7 Gy in one fraction was administered to achieve satisfactory local control, prevent potential further bleeding and reduce the risk of progressive neurological deficits. Stable size of the tumour and absence of any complications are confirmed in six years of follow-up.
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Affiliation(s)
- Dorota Księżniak-Baran
- I Radiation and Clinical Oncology Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute, Gliwice Branch, Poland
| | - Sławomir Blamek
- Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute, Gliwice Branch, Poland
| | - Agata Roch-Zniszczoł
- Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute, Gliwice Branch, Poland
| | - Wojciech Osewski
- IT Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute, Gliwice Branch, Poland
| | - Maja Jędrzejewska
- Department of Radiology and Diagnostic Imaging, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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12
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Noblett DA, Chang J, Toussi A, Dublin A, Shahlaie K. Hemangioma of the Cavernous Sinus: A Case Series. J Neurol Surg Rep 2018; 79:e26-e30. [PMID: 29707473 PMCID: PMC5919774 DOI: 10.1055/s-0038-1641731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/02/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Cavernous sinus hemangiomas (CSHs) are rare, vascular, extra-axial tumors that are diagnosed with a combination of imaging and biopsy. We describe the clinical presentations, imaging findings, and management of two male patients with CSHs. Case Report Case 1 describes a 57-year-old man who presented with vision changes and cranial nerve palsies. Initial imaging and surgical biopsy were nondiagnostic. Follow-up Tc-99m tagged red blood cell (RBC) imaging supported CSH diagnosis. He was treated with surgical resection and radiotherapy. Case 2 describes a 57-year-old man who presented with chronic headache. Imaging findings were suggestive of CSH. He underwent endoscopic endonasal surgical resection and a final diagnosis of CSH was made via biopsy. Discussion CSHs often present with headache, vision changes, and cranial nerve palsies. Characteristic findings of a T2 hyperintense lesion with homogeneous contrast enhancement has been described in the literature. There is also a role for tagged RBC imaging studies in the setting of nondiagnostic imaging and biopsy. Surgical resection can be difficult due to tumor vascularity and encasement of internal carotid arteries. Stereotactic radiosurgery and adjuvant radiotherapy can play a role in the treatment of patients who have inoperable lesions or subtotal resections.
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Affiliation(s)
- Dylan A Noblett
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Jennifer Chang
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Atrin Toussi
- Departments of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Arthur Dublin
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Kiarash Shahlaie
- Departments of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
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13
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Park S, Yoon SM, Lee S, Park JH, Song SY, Lee SW, Ahn SD, Kim JH, Choi EK. Role of fractionated radiotherapy in patients with hemangioma of the cavernous sinus. Radiat Oncol J 2017; 35:268-273. [PMID: 29037018 PMCID: PMC5647752 DOI: 10.3857/roj.2017.00199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/28/2017] [Accepted: 07/10/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose We performed this retrospective study to investigate the outcomes of patients with hemangioma of the cavernous sinus after fractionated radiotherapy. Materials and Methods We analyzed 10 patients with hemangioma of the cavernous sinus who were treated with conventional radiotherapy between January 2000 and December 2016. The median patient age was 54 years (range, 31–65 years), and 8 patients (80.0%) were female. The mean hemangioma volume was 34.1 cm3 (range, 6.8–83.2 cm3), and fractionated radiation was administered to a total dose of 50–54 Gy with a daily dose of 2 Gy. Results The median follow-up period was 6.8 years (range, 2.2–8.8 years). At last follow-up, the volume of the tumor had decreased in all patients. The average tumor volume reduction rate from the initial volume was 72.9% (range, 18.9–95.3%). All 10 of the cranial neuropathies observed before radiation therapy had improved, with complete symptomatic remission in 9 cases (90%) and partial remission in 1 case (10%). No new acute neurologic impairments were reported after radiotherapy. One probable compressive optic neuropathy was observed at 1 year after radiotherapy. Conclusion Fractionated radiotherapy achieves both symptomatic and radiologic improvements. It is a well-tolerated treatment modality for hemangiomas of the cavernous sinus.
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Affiliation(s)
- Sunmin Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sumin Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Schwyzer L, Tuleasca C, Borruat FX, Radovanovic I, Levivier M. Gamma Knife surgery for a hemangioma of the cavernous sinus in an adult: Case report and short review of the literature. Neurochirurgie 2017; 63:320-322. [PMID: 28882603 DOI: 10.1016/j.neuchi.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/13/2017] [Accepted: 05/03/2017] [Indexed: 02/01/2023]
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.
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Affiliation(s)
- L Schwyzer
- Department of neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - C Tuleasca
- Neurosurgery service and Gamma Knife center, Lausanne university hospital (CHUV), 44-46, rue du Bugnon, BH-08, 1011 Lausanne, Switzerland; Swiss federal institute of technology (EPFL), signal processing laboratory (LTS5), Lausanne, Switzerland; University of Lausanne, faculty of biology and medicine, Lausanne, Switzerland.
| | - F-X Borruat
- University of Lausanne, faculty of biology and medicine, Lausanne, Switzerland; Department of ophthalmology, hôpital ophtalmique Jules-Gonin, Lausanne, Switzerland
| | - I Radovanovic
- Department of neurosurgery, university of Toronto, Toronto, Canada
| | - M Levivier
- Neurosurgery service and Gamma Knife center, Lausanne university hospital (CHUV), 44-46, rue du Bugnon, BH-08, 1011 Lausanne, Switzerland; University of Lausanne, faculty of biology and medicine, Lausanne, Switzerland
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15
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Mahajan A, Rao VRK, Anantaram G, Polnaya AM, Desai S, Desai P, Vadapalli R, Panigrahi M. Clinical-radiological-pathological correlation of cavernous sinus hemangioma: Incremental value of diffusion-weighted imaging. World J Radiol 2017; 9:330-338. [PMID: 28932362 PMCID: PMC5583528 DOI: 10.4329/wjr.v9.i8.330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/18/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To elucidate the clinical, magnetic resonance imaging (MRI), pathological features of these lesions and asses the incremental value of diffusion-weighted imaging (DWI) in diagnosing them.
METHODS Fifteen consecutive patients (11 females and 4 males; mean age 40.93 years; age range 13-63 years) with cavernous sinus hemangiomas (CSH) who underwent examination between November 2008 and May 2016 were included for the analysis. MRI, clinical and surgical findings of each patient was retrospectively reviewed. DWI were also analysed and mean-apparent diffusion coefficient (ADC) value was calculated. Eleven patients underwent surgical removal of the lesion and 2 patients had biopsy only. Diagnosis of CSH was confirmed histologically in 13 patients.
RESULTS Eleven patients (73%) presented with headaches and 10 (66%) had cranial nerve involvement. Extra cavernous sinus extension was noted in 14 (94%). Surgery was performed in 13 (87%) and post-operative radiation was given to 4 (28%) patients. Thirteen patients remained asymptomatic on follow up. Three conspicuous imaging features were highly suggestive of the diagnosis: Lack of diffusion restriction (100%), homogeneous hyperintensity on T2 weighted image sequences (93.3%) and intense post-contrast enhancement (100%). The mean ADC was 1.82 × 10-3 ± 0.2186 cm2/s.
CONCLUSION T1-weighted hypointensity with homogeneous hyperintensity on T2-weighted sequences, intense enhancement and absence of hemosiderin within the lesion on GRE sequence favour the diagnosis. Facilitated diffusion on DWI differentiates CSH from other solid cavernous sinus lesions and significantly improves the diagnostic accuracy, a critical factor for planning surgery.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai 400012, India
| | - Vedula Rajni Kanth Rao
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad 500003, India
| | - Gudipati Anantaram
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad 500003, India
| | - Ashwin M Polnaya
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai 400012, India
| | - Sandeep Desai
- Department of Radiodiagnosis Clumax Imaging, Bangalore 560011, India
| | - Paresh Desai
- Department of Radiology, Apollo Victor Hospital, Goa 403601, India
| | - Rammohan Vadapalli
- Department of Radiology, Vijaya Diagnostics, Hyderabad, Secunderabad 500003, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad 500003, India
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16
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Meincke J, Lützen N, Doostkam S, Urbach H. Teaching Neuroimages: "Filling out" in Cavernous Hemangioma of the Cavernous Sinus. Clin Neuroradiol 2017; 28:137-138. [PMID: 28721610 DOI: 10.1007/s00062-017-0607-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- J Meincke
- Dept. of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - N Lützen
- Dept. of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - S Doostkam
- Dept. of Neuropathology, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - H Urbach
- Dept. of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.
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17
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Park CK, Choi SK, Kang IH, Choi MK, Park BJ, Lim YJ. Radiosurgical considerations for cavernous sinus hemangioma: long-term clinical outcomes. Acta Neurochir (Wien) 2016; 158:313-8. [PMID: 26658989 DOI: 10.1007/s00701-015-2657-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/30/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cavernous hemangiomas are rare vascular tumors in the cavernous sinus. Cranial neuropathies induced by cavernous sinus hemangiomas (CSH) necessitate tumor reduction, but surgery is extremely difficult due to the abundant vascularization of the lesion. We studied the effectiveness and safety of Gamma Knife radiosurgery (GKRS) for CSH. METHODS We performed a retrospective analysis of 25 patients with CSH who were treated by GKRS between March 1992 and December 2014. Age, sex, target volume, and irradiation dose were analyzed as prognostic factors for CSH treated by GKRS. RESULTS Eleven (84.6 %) patients had tumor shrinkage within 12 months after GKRS. Two patients experienced tumor progression, but tumor size decreased over 2 years after GKRS. No patients had permanent complications, and all patients experienced symptomatic improvement. There were no significant factors that predicted the prognosis of CSH. CONCLUSIONS The optimal treatment for CSH has been unclear; however, in this study, GKRS was an effective and safe treatment for CSH. Thus, GKRS may be a primary treatment for CSHs in high-risk surgery patients.
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Affiliation(s)
- Chang Kyu Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Il Ho Kang
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Man Kyu Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Bong Jin Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Young Jin Lim
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea.
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18
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Narvid J, Talbott JF, Glastonbury CM. The caverno-apical triangle: anatomic-pathological considerations and pictorial review. Clin Imaging 2015; 40:23-32. [PMID: 26481233 DOI: 10.1016/j.clinimag.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The caverno-apical triangle (CAT) is defined from the components that define its contours: the cavernous sinus and the orbital apex. A wide range of pathologies arise from the space between the cavernous sinus and the orbital apex. OBJECT To better define radiologically this critical anatomic landmark and establish an organized approach for image analysis to help generate focused differential diagnoses and accurately characterize lesions found on imaging. CONCLUSION We have identified common imaging characteristics of frequently encountered lesions and divided them into specific categories to facilitate creation of logical and focused differential diagnoses.
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Affiliation(s)
- Jared Narvid
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Jason F Talbott
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Christine M Glastonbury
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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19
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Tang X, Wu H, Wang B, Zhang N, Dong Y, Ding J, Dai J, Yu T, Pan L. A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases. Acta Neurochir (Wien) 2015; 157:961-9; discussion 969. [PMID: 25862173 DOI: 10.1007/s00701-015-2417-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/26/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cavernous sinus hemangiomas (CaSHs) are rare vascular lesions in the cavernous sinus(CS). Gamma Knife radiosurgery (GKS) provides a treatment modality alternative to microsurgery. This study was conducted to describe a new classification of CaSHs based on their magnetic resonance (MR) imaging findings and determine the efficacy and safety of GKS in a large series of CaSH patients. METHODS From April 2007 to November 2012, 53 patients harboring CaSHs were treated using Leksell Gamma Knife model C (before April 2012) or Perfexion (from May 2012 ) at the Gamma Knife Center of Huashan Hospital. Of the 53 patients, 15 with definitive histopathologic diagnoses after surgery, 38 were diagnosed based on their MR imaging findings. There were 15 male and 38 female patients with a mean age of 52 (range, 25-76) years old. The characteristics of MR images of CaSHs were their extremely high homogeneous intensity on T2-weighted and FLAIR images: as bright as cerebrospinal fluid signal. According to the relationship between the carotid line and their location, CaSHs were classified into three types: the intrasellar, parasellar and mixed type. The mean volume of the tumors was 13.2 ± 8.2 cm(3) (range, 1-41 cm(3)). A mean marginal dose of 13.3 Gy (range, 8-15 Gy) was directed to the 49%-64% isodose line (mean 53%). RESULTS Of the 53 tumors, 6 (11%) were classified as intrasellar type. Eight (15%) were parasellar type and the other 39 cases(74%) mixed type. The mean radiological and clinical follow-up time of this study was 24 (range, 2-67 months) and 34 months (range, 2-73 months), respectively. The tumor control rate was 100%. The mean tumor volume reduction was 79.5% (range, 16.5%-100%) compared with the pre-GKS volume. Six months after GKS, MR imaging revealed an average of 60.2% tumor volume reduction (range, 16.5%-89.2%). Twenty-nine cases (55%) showed a >80% tumor volume decrease. Neurologically, only two of these patients showed clinical deterioration, and 33 patients demonstrated an obvious improvement in ocular or endocrine disorders. At last follow-up, there were no more complications related to GKS, and none of the tumors progressed. CONCLUSIONS Our study showed that GKS is a useful and safe therapeutic method for CaSHs as both a primary and adjuvant treatment. The new classification of CaSHs may help predict their clinical course during tumor development and treatment response after GKS. Further studies with long-term follow-up and larger numbers of cases are necessary to optimize the treatment conditions and verify the benefit of this treatment.
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20
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Ding D. Recovery of neurological function after stereotactic radiosurgery for skull base tumors. Clin Neurol Neurosurg 2015; 132:31-32. [PMID: 25746319 DOI: 10.1016/j.clineuro.2015.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/29/2015] [Accepted: 02/13/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Dale Ding
- University of Virginia, Department of Neurosurgery, Charlottesville 22908, USA.
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