Interdisciplinary multi-step treatment of a giant cavernous sinus hemangioma:

Abstract

Objective: Hemangiomas within the cavernous sinus are findings. They differ considerably from cerebral cavernous malformations since they are highly vascularized lesions, which grow over time, compress and distort adjacent cranial nerves, and may reach large size before they becomesymptomatic. Clinical Presentation: The authors report their treatment approach to a 22-year old female patient with progressive visual deterioration and opthalmoparesis on the right side. State-of-the-art MRI revealed a well vascularized lesion in the right cavernous sinus, consistent with a giant hemangioma. Intervention: Nearly complete tumor resection was successfully achieved in a two-step procedure. After the initial resection of the intracavernous part of the lesion, embolization of the remaining supratentorial part was performed. The subsequent treatment of the small remnant was followed by fractionated radiotherapy using IMRT technique (total dose of 40 Gy). Conclusion: Giant cavernous sinus hemangiomas are extraaxial vascular lesions whose considerable size may impede the standard surgical approach. Thus, a close interdisciplinary cooperation between neurosurgeons, neuroradiologists and radiotherapist is of paramount importance.