Cavernous Hemangioma of the Cavernous Sinus-Same Pathology, Different Disease: 2-Dimensional Operative Video.

Abstract

Cavernous sinus cavernous hemangiomas (also known as cavernomas) and intra-axial cavernomas share identical histologic features; however, their epidemiology, clinical behavior, and surgical management are quite different. Cavernous sinus cavernous hemangiomas behave more like neoplasms with progressive growth and mass effect, as opposed to intraparenchymal cerebral cavernomas that present with repeated hemorrhages.1,2 Cavernous sinus cavernous hemangiomas are uncommon benign lesions arising within the cavernous sinus, often extending into the sellar, suprasellar, and middle cranial fossa regions.3,4 Debate continues about their nature as vascular malformations.5 Clinical manifestations typically consist of cranial neuropathies rather than hemorrhagic events. Although radiosurgery was found to be ineffective in treatment of cavernomas,6 radiation7 and radiosurgery8,9 have occasionally been reported to reduce cavernous sinus cavernous hemangioma volume, although these modalities are not curative, and data on long-term control are lacking. Furthermore, the patients are frequently young. Therefore, surgical excision is the preferred treatment10,11 and can be accomplished through a purely extradural approach because the lesion remains enveloped by the dural leaves.3,12,13 Operating extradurally minimizes the risk of injury to the brain parenchyma, allows proximal control of the internal carotid artery, and provides access to the cavernous sinus through the corridors between the cranial nerves. Cavernous sinus cavernous hemangiomas are highly vascular, and proactive mitigation of blood loss is essential.3 We demonstrate the resection technique in a 40-year-old patient who consented to surgery. The image at 1:30, © Ossama Al-Mefty, is used with permission.