Francisca Montoya1, Aaron Vidal2, Francisco Sepulveda2, Roberto Marileo2, Joseline Caro2, Mauricio Castillo3. 1. Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile. Electronic address: fran.montoya@gmail.com. 2. Neuroradiology Division, Instituto de Neurocirugía Dr. Asenjo, Santiago, Chile. 3. Neuroradiology Division, Chapel Hill, North Carolina, USA.
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.
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.
Authors: J C Benson; K L Eschbacher; A Raghunathan; D Johnson; D K Kim; J Van Gompel Journal: AJNR Am J Neuroradiol Date: 2021-11-11 Impact factor: 3.825
Authors: Temidayo Osunronbi; Pinky May Myat Noe Pwint; John Usuah; John Cain; Sachin Mathur; Nihal T Gurusinghe; Gareth A Roberts; Andrew F Alalade Journal: Neurosurg Rev Date: 2022-04-25 Impact factor: 2.800