Elsevier

Clinical Imaging

Volume 37, Issue 4, July–August 2013, Pages 744-746
Clinical Imaging

Case Report
Cavernous hemangioma of the cavernous sinus misdiagnosed as a meningioma: a case report and MR imaging findings

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Abstract

Cavernous hemangioma (CH) is a benign vascular malformation. Intracranial CH is generally localized as an intracranial–intraaxial and responsible for 5–13% of all intracranial vascular malformations. Intracranial–extraaxial CHs are rare rather than intracranial–intraaxial CHs. Clinical findings, imaging characteristics, and surgical approach of extraaxial CHs are rather different than intraaxial CHs. Diagnosing cavernous sinus CH preoperatively is very important, but its radiological differential diagnosis is quite difficult. In this study, we present magnetic resonance imaging findings of a 48-year-old male who was considered preoperatively to have meningioma but was diagnosed with cavernous sinus CH during surgery by pathological examination.

Introduction

Cavernous hemangioma (CH) is a benign vascular malformation which can affect most of organ systems including the central nervous system. Intracranial CH is generally localized as an intracranial–intraaxial and responsible for 5–13% of all intracranial vascular malformations [1]. Intracranial CH's rate among general population is 0.5–1% [2], [3]. Intracranial–extraaxial CHs are located at the cavernous sinus or cerebellopontine angle in the middle cranial fossa [4], [5]. Composed of extraaxial CHs is 0.4–2% of all intracranial CHs, less than 1% of all parasellar masses and less than 2% of all cavernous sinus tumors [6], [7], [8]. Clinical findings, imaging characteristics, and surgical approach of extraaxial CHs are rather different than intraaxial CHs [5].

Diagnosing cavernous sinus CH preoperatively is very important, but its radiological differential diagnosis is quite difficult. Cavernous sinus CHs are usually misdiagnosed as a meningioma because meningioma is a common lesion [1], [9]. Since CHs are rich in vascular structures and near the important neurovascular structures, its removal by surgery is both difficult and has serious complications [10]. In this study, we present magnetic resonance (MR) imaging findings of a 48-year-old male who was considered preoperatively to have meningioma but was diagnosed with cavernous sinus CH during surgery by pathological examination.

Section snippets

Case report

A 48-year-old male presented to our neurology with history of intermittent headache for a month. There was no abnormality on neurological examination. Hypothalamo–hypopysis hormone levels were studied for differential diagnosis, and hormone levels were within the normal range. There was no abnormality in blood count and biochemistry studies. Sellar-left parasellar lesion with high density was found on cranial computed tomography (CT). Contrast-enhanced MR imaging was studied for further

Discussion

Cavernous sinus CH can be originated from intracavernous components or extracavernous tissues that are adjacent to cavernous sinus [4], [11]. Extracranial and intracranial–intraaxial CHs are similar histologically, and they consist of vascular channels lined with a single layer of endothelium, which does not contain smooth muscle [12]. CH grows gradually and causes symptoms due to its pressure on adjacent structures [4], [11]. These symptoms are usually headache, cranial nerve dysfunction,

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