Small Cavernous Hemangioma Research Articles

3D Slicer and 3D printing localization combined with neuroendoscopic surgery for the treatment of deep cerebral cavernous hemangioma

To explore the advantages and disadvantages of 3D Slicer reconstruction and 3D printing localization combined with transcranial neuroendoscope in the surgical treatment of deep cerebral micro cavernous hemangiomas. Method The clinical data of patients with deep cerebral micro cavernous hemangiomas treated by our hospital from June 2022 to February 2023 using 3D Slicer reconstruction and 3D printing localization technology combined with transcranial endoscopic surgery were retrospectively analyzed. A total of 5 cases with complete data were collected, including 2 males and 3 females, aged 9–59 years. All 5 patients had deep supratentorial cavernous hemangiomas with a diameter of less than 1.5 cm, and had clinical symptoms such as headache or epilepsy, and had been diagnosed by CT or MRI. Repeated bleeding from small cavernous hemangiomas in the deep brain can lead to clinical symptoms such as recurrent headache and epilepsy, and is required surgical treatment. However, cavernous hemangiomas often have smaller lesions and are difficult to locate in the deep part. Without neuronavigation, surgery can become extremely difficult. Our team’s newly developed 3D Slicer reconstruction and 3D printing localization technology which could provide new options for surgical treatment of small cavernous hemangiomas or other small lesions in the deep brain, but its accuracy and safety still need to be verified by further clinical research.

Removal of Small Cavernous Hemangioma in Orbital Apex Through an Endoscopic Transethmoidal-Sphenoidal Approach.

To investigate the feasibility, efficacy, and safety of an endoscopic transethmoidal-sphenoidal approach in removing a small cavernous hemangioma (CH) located in the deep lateral orbital apex. This study involved 19 patients diagnosed with a CH located in the deep lateral orbital apex. All patients underwent an endoscopic transethmoidal-sphenoidal approach for removal of the CH. The best-corrected visual acuity (BCVA), visual field, and surgery-related complications were analyzed and compared. All tumors in this study were completely removed. The mean BCVA was LogMAR 0.97 ± 0.97 preoperatively and LogMAR 0.38 ± 0.64 postoperatively (p < 0.05). The mean visual field index was 52.26% ± 33.26% preoperatively and 75.47% ± 30.49% postoperatively (p < 0.05). The mean deviation index was -17.48 ± 12.43 dB preoperatively and -10.10 ± 10.85 dB postoperatively (p < 0.05), and the pattern standard deviation was 6.37 ± 3.77 dB preoperatively and 4.90 ± 3.56 dB postoperatively (p >0.05). Four (21.1%) patients developed oculomotor limitations and two (10.5%) patients developed ptosis after surgery. All of these symptoms resolved spontaneously, and no other complications occurred. The mean follow-up time was 6.71 ± 3.89 months. The endoscopic transethmoidal-sphenoidal approach is an effective and minimally invasive treatment for removing small CH in the deep lateral orbital apex. 4 Laryngoscope, 132:1743-1749, 2022.

Endoscopic Transethmoidal Approach with or without Medial Rectus Detachment for Orbital Apical Cavernous Hemangiomas

To determine the indications for the addition of a transcaruncular approach along with detachment of the medial rectus muscle during the removal of small apical cavernous hemangiomas using an endoscopic transethmoidal approach. Retrospective, noncomparative case series. Multicenter study of 12 patients with apical orbital tumors removed using an endoscopic transethmoidal approach. The decision to detach the medial rectus muscle with the addition of a transcaruncular approach was made during surgery for tumors largely lateral to the medial rectus muscle. Tumors adjacent to the medial orbital wall were removed via an endoscopic transethmoidal approach alone. Seven tumors were removed via an endoscopic transethmoidal approach combined with medial rectus muscle detachment, whereas 5 patients underwent removal without detachment of the medial rectus. All patients had visual impairment. Complete excision of the hemangiomas was achieved in all patients and tumor size ranged from 6 × 5 mm to 20 × 12 mm. The mean postoperative follow-up time was 11.8 ± 4.3 months. At final follow-up, the best-corrected visual acuity improved in 11 patients. Three patients had transient horizontal diplopia resulting from partial paralysis of the medial rectus muscle after detachment during surgery. The endoscopic transethmoidal approach with or without medial rectus detachment is a promising approach for selected small cavernous hemangiomas located at the deep medial orbital apex. Detachment of the medial rectus muscle can be a useful technique for tumors located largely lateral to the medial rectus muscle. Further studies will be required to demonstrate the safety and efficacy of this technique.

Ketamine as an Adjunct to Morphine in Postthoracotomy Analgesia

Ketamine as an Adjunct to Morphine in Postthoracotomy Analgesia

Lipiodol-CT for hepatocellular carcinoma

Lencioni et al. have nicely presented a positive predictive value of Lipiodol CT for intrahepatic metastasis of hepatocellular carcinoma (HCC) based on 32 consecutive patients undergoing hepatectomy [1]. Lipiodol-CT has been generally regarded as a highly sensitive examination to detect intrahepatic metastases because these mostly occur in hypervascular HCC (advanced or classic HCC, histopathologically moderately or poorly differentiated) and have a similarly hypervascular character. However, there has been no direct confirmation of high sensitivity and specificity by this method. Theoretically and clinicopathologically, Lipiodol is distributed in loci according to their vascularity. Long-term deposits are noted in the necrotic area of the tumor and liver parenchyma, especially after embolization [2]. Thus, any hypervascular nodular lesion such as small cavernous hemangioma and focal nodular hyperplasia and nontumorous area such as focal inflammation and arterioportal shunt could be false-positive cases of intrahepatic metastasis, although the durations of deposit are different case by case [2]. Such cases have been sporadically reported [3, 4]. Lencioni et al. have defined a positive finding of intrahepatic metastasis at Lipiodol-CT as a small, rounded, well-delineated retention less than 2 em in diameter but have not described any pathologic definition or finding. In general, intrahepatic metastases are present in cases with HCC associated with portal tumor thrombus, multiple in number, small in size, and located adjacent to the main tumor [5]. However, intrahepatic metastasis is not a self-evident lesion, especially in patients at high risk for HCC who often have multicentricoccurring tumors of different or same subtype. Even when using DNA analysis, pathologists cannot necessarily confirm whether or not a particular lesion is an intrahepatic metastasis [5, 6].

Small hepatocellular carcinoma versus small cavernous hemangioma: differentiation with MR imaging at 2.0 T.

Eighteen small hepatocellular carcinomas (HCCs) and 38 hemangiomas less than 5 cm in diameter were studied with magnetic resonance (MR) imaging at 2.0 T. Relatively T1-weighted spin-echo (SE) 500/30 (repetition time msec/echo time msec) images and proton-density 2,000/30 images showed nonspecific contrast-to-noise ratios (C/Ns) and intensity ratios in HCCs and hemangiomas. On T2-weighted 2,000/60, 90, 120, 150, and 180 images, hemangiomas had significantly greater C/N and intensity ratios than HCCs (P less than .05). The SE 2,000/180 sequence showed the greatest difference in tumor-liver intensity ratios between small HCCs and hemangiomas, followed by the SE 2,000/150 sequence, but there was no statistically significant difference between the two pulse sequences. However, the SE 2,000/180 sequence is limited in the number of sections obtainable for routine clinical liver imaging. The findings indicate that the SE 2,000/60 sequence is optimal for the detection of small HCCs and hemangiomas and that the SE 2,000/150 sequence is optimal for distinguishing small HCCs from hemangiomas at 2.0 T.

Partial seizures with visual disturbance treated by radiotherapy of cavernous hemangioma

A man aged 26 years had been subject to frequent transient episodes of left homonymous hemianopia, initially accompanied by visual hallucinations and left miosis, since the age of 8 years. These partial seizures recurred 3 to 30 times each month in spite of treatment with anticonvulsant medication. The causative lesion, which had escaped detection by cerebral angiography and repeated computed tomographic scanning, was shown by magnetic resonance imaging to be a small cavernous hemangioma in the right occipital lobe. This was treated by a course of fine-beam radiotherapy directed to the lesion. After treatment the partial attacks ceased, although one nocturnal clonic seizure occurred 12 months after radiotherapy and 6 weeks after stopping all anticonvulsant medication.

Noninvasive diagnosis of small cavernous hemangioma of the liver: advantage of MRI.

Thirty-three lesions of small cavernous hemangioma of the liver under 3 cm in diameter detected by sonography, computed tomography (CT), or magnetic resonance imaging (MRI) were reviewed. Sonography detected 23 lesions, plain CT 15 out of 26, and MR 31, including one equivocal. On sonography, 18 of 23 revealed a strong, almost homogeneous hyperechoic mass without a rim. On CT, eight of 33 showed characteristic findings of hemangioma by contrast enhancement. On MRI, 26 of 31 appeared as a markedly high-intensity area, which was rarely the appearance of other hepatic tumors of similar size. Spin-spin relaxation time (T2) of hemangioma was prolonged over 80 msec in 15 of 18 while one of 20 lesions in patients with primary or secondary liver cancers under 3 cm showed T2 of 80 msec or more. MRI in addition to sonography and/or CT allowed detection of almost all cavernous hemangiomas over 1 cm in diameter and diagnosis with considerably high accuracy and specificity. MRI will play an important role in determination of necessity of further invasive diagnostic methods for patients with small liver tumors detected by sonography and/or CT.

Cerebrovascular diseases in the first three years of life

Congenital and acquired cerebrovascular diseases in the very young age group are reviewed and discussed. Whilst saccular aneurysms are rare arteriovenous malformations and cavernous hemangiomas represent the most frequent types of all congenital anomalies. The aneurysm of the great vein of Galen manifests in the newborn period and mostly is mistaken for congenital heart disease. If the infant survives this angioma causes hydrocephalus. A particular type of phakomatosis combines intracerebral pure venous malformation with homolateral port-wine nevus on the front, often causing epileptic seizures. Spontaneous intracerebral hemorrhage occurs in children with small cavernous hemangiomas. Acquired arterial lesions may develop during fetal life by embolism, causing porencephaly or unilateral brain atrophy. The "Moyamoya" syndrome represents a frequent multi-arterial lesion causing characteristic ischemic episodes. Etiology is still obscure. We do not even know if the disease is acquired or congenital.