Diagnosis and surgical treatment of cavernous sinus cavernous hemangiomas

Objective To elucidate the advances of diagnosis and surgical treatment of the cavernous sinus cavernous hemangiomas(CSHAs). Methods The data from 20 patients with CSHAs surgically treated by authors from 1996 through 2000 were analyzed retrospectively and a review of relevant literature was conducted. Results These 20 cases accounted for 16.3% of all intracranial cavernous hemangiomas surgically treated in the same period at Huashan Hospital. The common clinical manifestations were visual loss, diplopia, headache, facial numbness and extraocular muscle palsy. CT and MRI were major preoperative diagnostic modalities, but the demonstration was non specific features. The preoperative misdiagnostic rate was 38.9%. The 20 patients underwent craniotomy via modified pterional approach with or without orbitozygomatic osteotomy. The tumors were removed through epidural approach (EDA) in 13 cases and intradural approach (IDA) in 7 cases. Total tumor removal was achieved in 12 cases(92.3%)in the EDA group and 0 in the IDA group. Incomplete tumor removal was 1 case(7.7%)in the EDA group and 7 cases(100%)in the IDA group. Follow up study(range:1～6 years, mean: 3 years)was available in 17 patients(89%).All patients in the EDA group improved without tumor recurrence . In the IDA group, there were no improvement in 2 cases and worsening in 3 cases. In tumors incompletely removed, they enlarged in 2 cases, unchanged or decreased in size in 3 cases in which 2 cases underwent postoperative radiosurgery or radiotherapy. Conclusion Cavernous hemangiomas should be included in differential diagnosis for middle age females with cavernous sinus tumors. The best microsurgical approach for the removal of the CSHAs is epidural approach via the skull base craniotomy. Radiosurgery should be considered for patients with incomplete tumor removal.