Extracerebral cavernous angiomas of the cavernous sinus in the middle fossa

• Published in: Surgical neurology Vol. 45; no. 2; pp. 123 - 132
• Main Authors: Suzuki, Yoshio, Shibuya, Masato, Baskaya, Mustafa Kemal, Takakura, Shuji, Yamamoto, Masayuki, Saito, Kiyoshi, Glazier, Steven S., Sugita, Kenichiro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.1996
• Subjects: Adult; Aged; Cavernous sinus; Cavernous Sinus - pathology; extracerebral cavernous angioma; Female; Hemangioma, Cavernous - complications; Hemangioma, Cavernous - diagnosis; Hemangioma, Cavernous - pathology; Hemangioma, Cavernous - therapy; Humans; irradiation; Magnetic Resonance Imaging; Male; Middle Aged; middle fossa; Retrospective Studies; surgical treatment; Tomography, X-Ray Computed; Cavernous sinus; middle fossa; surgical treatment; extracerebral cavernous angioma; irradiation
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/S0090-3019(96)80004-8

BACKGROUND Intracranial extracerebral cavernous angiomas (ECCAs) share the same histologic features as intracerebral lesions, but their clinical picture is different. Surgical treatment of ECCAs of the cavernous sinus remains a challenge for the neurosurgeon because of a high mortality and morbidity due to uncontrollable and massive hemorrhage. METHODS We have experienced seven patients with ECCAs of the cavernous sinus between 1982 and 1994. All cases were verified histologically during surgery and two were totally resected during the first surgical attempt. Six of seven patients were female. The mean age at diagnosis was 54.5 years (range: 43 to 71 years). RESULTS Computed tomography showed a round or dumbbell-shaped mass in the area of the cavernous sinus. Magnetic resonance imaging revealed a low to isointense mass lesion on the T 1-weighted image, which then showed extremely high intensity on the T 2-weighted image. Only one of our patients showed a minimal amount of vascular staining on angiography. The total excision of these malformations was difficult because intraoperative bleeding could be profuse. In one case, radiation therapy induced a reduction in the size of the tumor after failure of surgical removal. CONCLUSIONS In planning surgical strategy for ECCAs, care should be taken to control the massive bleeding. Radiation therapy is helpful to suppress the tumor growth.