Symptomatic Cavernous Hemangiomas Research Articles

Heme-Pigment Induced Acute Kidney Injury after Cavernous Hemangioma Ablation.

Cavernous hemangiomas are the most common benign liver mass, occurring with up to 7.3% incidence.[1] Giant cavernous hemangiomas—defined as those exceeding 5 cm in diameter—can stretch the liver capsule and prompt abdominal pain in approximately 40% of patients.[2] Radiofrequency ablation (RFA) is employed to treat symptomatic cavernous hemangiomas, and has shown superior effectiveness at alleviating pain—as well as shorter procedure time and reduced blood loss—in comparison to traditional open surgical resection.[3] Acute kidney injury (AKI) is a rare complication of RFA of giant cavernous hemangiomas. This complication, which is due to heme-pigment released in the setting of massive red blood cell (RBC) hemolysis during the procedure, is uncommon, having been described in only a few cases in the literature.[4] [5] Herein, we present an illustrative case of AKI following RFA of a giant cavernous hemangioma requiring hospitalization and aggressive intravenous (IV) hydration, and we discuss risk factors, diagnostic criteria, avoidance strategies, and management approaches for this uncommon adverse event.

Benign Neoplasms of the Orbit

Benign orbital neoplasms comprise a wide spectrum of different entities. The origin of the tumours can be epithelial or mesenchymal. Epithelial neoplasms of the orbit originate from the lacrimal gland. The most important tumour is the pleomorphic adenoma, which should not be biopsied but resected in toto. The most common intraconal neoplasm in adults is the cavernous hemangioma. Symptomatic cavernous hemangiomas should be treated. The treatment of choice for most symptomatic benign neoplasms of the orbit is surgical resection. Suitable surgical approaches are anterior transconjunctival and lateral orbitotomy. Cryoextraction is a minimally invasive technique that is particularly suitable for cavernous hemangiomas.

Symptomatic cavernous hemangioma of fronto-parietal region of the brain in a young female patient – a case report

Symptomatic cavernous hemangioma of fronto-parietal region of the brain in a young female patient – a case report

Embolization of a Giant Hepatic Hemangioma Prior To Urgent Liver Resection. Case Report and Review of the Literature

Cavernous hemangiomas are the most common benign tumors of the liver [1–3]. The origin of these tumors is a subject of debate. Some authors consider them hamartomatous in origin, present at birth and growing slowly thereafter, while others consider them to be true vascular neoplasms [4]. Most of them are small (<4 cm in diameter) and asymptomatic and are discovered incidentally during screening tests by modern diagnostic procedures. Giant hemangiomas are larger than 4 cm in diameter and occasionally present with abdominal pain. Spontaneous rupture of a giant hemangioma has been described, but it is extremely rare [5]. Transcatheter arterial embolization has been suggested as a good treatment of such symptomatic cavernous hemangiomas of the liver, used either alone or as a preoperative procedure prior to surgical resection [6–8]. We present a case of a giant hemangioma of the liver treated with preoperative transcatheter arterial embolization, followed by surgical resection at the same time. Case Report

Ultrasonography-guided Percutaneous Radiofrequency Ablation for Treatment of a Huge Symptomatic Hepatic Cavernous Hemangioma

Ultrasonography-guided Percutaneous Radiofrequency Ablation for Treatment of a Huge Symptomatic Hepatic Cavernous Hemangioma

Ultrasonography-guided Percutaneous Radiofrequency Ablation for Treatment of a Huge Symptomatic Hepatic Cavernous Hemangioma

Ultrasonography-guided Percutaneous Radiofrequency Ablation for Treatment of a Huge Symptomatic Hepatic Cavernous Hemangioma

Gamma knife surgery for cavernous hemangiomas: an analysis of 125 patients

The authors sought to determine the value of gamma knife surgery (GKS) in the treatment of cavernous hemangiomas (CHs). Between 1993 and 2002, a total of 125 patients with symptomatic CHs were treated with GKS. Ninety-seven patients presented with bleeding and 45 of these had at least two bleeding episodes. Thirteen patients presented with seizures combined with hemorrhage, and 15 patients presented with seizures alone. The mean margin dose of radiation was 12.1 Gy and the mean follow-up time was 5.4 years. In the 112 patients who had bled the number of rebleeds after GKS was 32. These rebleeds were defined both clinically and based on magnetic resonance imaging for an annual rebleeding rate of 32 episodes/492 patient-years or 6.5%. Twenty-three of the 32 rebleeding episodes occurred within 2 years after GKS. Nine episodes occurred after 2 years; thus, the annual rebleeding rate after GKS was 10.3% for the first 2 years and 3.3% thereafter (p = 0.0038). In the 45 patients with at least two bleeding episodes before GKS, the rebleeding rate dropped from 29.2% (55 episodes/188 patient-years) before treatment to 5% (10 episodes/197 patient-years) after treatment (p < 0.0001). Among the 28 patients who presented with seizures, 15 (53%) had good outcomes (Engel Grades I and II). In this study of 125 patients, symptomatic radiation-induced complications developed in only three patients. Gamma knife surgery can effectively reduce the rebleeding rate after the first symptomatic hemorrhage in patients with CH. In addition, GKS may be useful in reducing the severity of seizures in patients with CH.

Gamma knife surgery for cavernous hemangiomas: an analysis of 125 patients

Object. The authors sought to determine the value of gamma knife surgery (GKS) in the treatment of cavernous hemangiomas (CHs). Methods. Between 1993 and 2002, a total of 125 patients with symptomatic CHs were treated with GKS. Ninety-seven patients presented with bleeding and 45 of these had at least two bleeding episodes. Thirteen patients presented with seizures combined with hemorrhage, and 15 patients presented with seizures alone. The mean margin dose of radiation was 12.1 Gy and the mean follow-up time was 5.4 years. In the 112 patients who had bled the number of rebleeds after GKS was 32. These rebleeds were defined both clinically and based on magnetic resonance imaging for an annual rebleeding rate of 32 episodes/492 patient-years or 6.5%. Twenty-three of the 32 rebleeding episodes occurred within 2 years after GKS. Nine episodes occurred after 2 years; thus, the annual rebleeding rate after GKS was 10.3% for the first 2 years and 3.3% thereafter (p = 0.0038). In the 45 patients with at least two bleeding episodes before GKS, the rebleeding rate dropped from 29.2% (55 episodes/188 patient-years) before treatment to 5% (10 episodes/197 patient-years) after treatment (p &lt; 0.0001). Among the 28 patients who presented with seizures, 15 (53%) had good outcomes (Engel Grades I and II). In this study of 125 patients, symptomatic radiation-induced complications developed in only three patients. Conclusions. Gamma knife surgery can effectively reduce the rebleeding rate after the first symptomatic hemorrhage in patients with CH. In addition, GKS may be useful in reducing the severity of seizures in patients with CH.

Surgical Treatment of Symptomatic Cavernous Hemangiomas of the Liver

Background: Elective surgery for liver hemangiomas is still controversial.Material and Methods: Twenty-one patients, all symptomatic, underwent surgery for liver hemangiomas between August 1986 and June 2001. The primary indications for surgery were abdominal pain in 12 patients, pain and enlargement in 4, bleeding after needle biopsy in 1 and diagnostic uncertainty and suspicion of malignancy in 4. Results: Enucleation was the choice of operation in 18 patients. Hospital mortality and morbidity were 0% and 9.52 % respectively. Mean follow-up period was 58.55 months (2-180). Mean hospitalization time was 15.6 days (8-75) and mean transfusion requirement was 2.1 units (0-18) of erythrocyte suspension. The median largest dimension of the major lesions was 12.71 cm (2-30).Conclusion: Elective surgery is indicated in a small subset of patients with hemangiomas because of abdominal pain, enlargement, diagnostic uncertainty and bleeding after needle biopsy. The results of surgery without any mortality and minimal morbidity are safe and effective. Enucleation is the preferred operation and can be performed rapidly and safely.

Symptomatic cavernous hemangioma of the occipital condyle treated with methacrylate embolization

BACKGROUND Cavernous hemangiomas of the cranial base are rare tumors. No case of symptomatic intraosseous angioma affecting the occipital condyle has been reported. This particular case was treated with surgical embolization using acrylic resin. CASE DESCRIPTION A 20-year-old man with a 1-year history of neck pain and torticollis was referred to our hospital. Neuroradiological examination revealed the typical picture of an intraosseous cavernous hemangioma located in the right occipital condyle. The patient was operated through a suboccipital approach. Biopsy and direct embolization with methacrylate was performed. The definitive pathological diagnosis confirms the neuro-radiological suspicion of intraosseous cavernous hemangioma. The follow-up of the patient (4 years) revealed no recurrence of pain or abnormal posture. CONCLUSIONS A rare case of cranial base cavernous hemangioma is reported. Methacrylate embolization can be a good option for the treatment of this uncommon lesion.

Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study.

This prospective study evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) for the treatment of symptomatic cavernous hemangiomas of the liver. The technique, its complications, and effectiveness also were analyzed. Eight patients (five male, three female; mean age +/- SD = 47.75 +/- 8.59 years) with symptomatic cavernous hemangiomas of the liver were treated by TAE with polyvinyl alcohol particles or gelfoam and steel coils (single session) followed by supportive treatment. Tumor characterization (including the extent and number of lesions) was done on triple-phase helical computed tomography or gadolinium-enhanced dynamic magnetic resonance imaging. The lesions were located in the right lobe in five patients, left lobe in one, and both lobes in two. The largest diameter of the lesions was 6-18 cm (9.28 +/- 5.13 cm). The treatment response was assessed on follow-up ultrasound and color Doppler and/or contrast-enhanced helical computed tomography. There were no treatment-related deaths and morbidity was minimal. Embolization was the only method of treatment in seven patients; however, one patient had surgery after TAE because the symptoms were only partly relieved. Indications for embolization were abdominal pain (eight patients), rapid tumor enlargement (four of eight), and recurrent jaundice (one of eight). Symptomatic improvement was documented in all patients after embolization. Symptoms did not worsen in any patient. The mean size of the tumor did not show any statistically significant change on follow-up radiologic examinations. However, in one patient, the tumor significantly regressed in size after embolization. TAE of hepatic cavernous hemangioma is a useful procedure in the therapy of symptomatic hemangiomas.

Cavernous angiomas of the cauda equina: case report and review of the literature

Background Cavernous hemangiomas of the spine and spinal cord are relatively uncommon lesions that are being discovered more frequently because of the increased use of magnetic resonance imaging (MRI). We present a rare case of a symptomatic cavernous hemangioma of the cauda equina. Case Description A 49-year-old woman presented to our institution with the chief complaint of low back pain of acute onset. On physical examination the patient was found to be tender to percussion over the lumbar spine, had tenderness over the sciatic nerve, loss of pinprick sensation over the right lateral foot and loss of the Achilles’ reflex on the right. In addition, she was found to have a large postvoid urinary bladder residual volume. MRI revealed a 20 mm × 11 mm nonenhancing, heterogenous mass obliterating the spinal canal at the L4 level. At operation, this lesion was found to be adherent to the nerve roots and was completely resected. Pathology revealed this lesion to be a cavernous angioma of the cauda equina. A review of the pertinent literature is presented. Conclusions Cavernous hemangiomas of the cauda equina are extremely rare lesions that may present as low back pain, neurologic deficit, or as subarachnoid hemorrhage. They can be successfully treated with surgical excision.

Transcatheter Arterial Embolization of Two Symptomatic Giant Cavernous Hemangiomas of the Liver

Transcatheter Arterial Embolization of Two Symptomatic Giant Cavernous Hemangiomas of the Liver

Hepatic Haemangopma: Enucleate or Resect?

Cavernous hemangiomas are the most common benign tumors of the liver. The results of natural history studies have demonstrated that asymptomatic hemangiomas can be observed without deleterious results. The appropriate treatment for symptomatic cavernous hemangiomas remains unclear. Since 1987, ten patients with symptomatic giant cavernous hemangiomas have undergone simple enucleation at the New England Deaconess Hospital, Boston, Massachusetts. Ten patients who underwent both anatomic and nonanatomic resections for benign hepatic tumors were chosen as a control group. We analyzed patient demographics and characteristics of the hospital course. Both groups had similar periods of hospitalization (9.5 ± 1.2 versus 9.1 ± 1.8 days; p = NS), operative time (2.2 ± 0.3 versus 2.4 ± 0.2 hours; p = NS) and lesion size (7.6 ± 1.3 versus 8.4 ± 1.2 centimeters; p = NS). The enucleation group had 49 percent less intraoperative blood loss whencompared with the resection group (400 ± 129 versus 742 ± 116 millimiters; p ＜ 0.05). Two units of blood were transfused in the enucleation group while 6 units were transfused in the resection group. Postoperatively, two patients in the resection group required computed tomographic guided drainage of extrahepatic bile collections. There were none in the enucleation group. Because enucleation is performed in the fibrous capsule composed of compressed hepatic parenchyma, injury to major bile ducts and blood vessels may be avoided. Enucleation is a safe alternative to resection for treatment of symptomatic giant hemangiomas.

Surgical Removal of Pontomesencephalic Cavernous Hemangiomas

Abstract Cavernous hemangiomas of the brain stem are usually discovered accidentally during evacuation of a hematoma, and successful surgical treatment of these lesions is seldom achieved. With the increasing use of magnetic resonance imaging, the presence of a cavernous hemangioma can be detected before surgery, allowing an elective surgical approach. We successfully removed pontomesencephalic cavernous hemangiomas from 2 patients and pontomedullary hemangiomas from 2 others. Elective surgery was performed with perioperative bimodal monitoring of somatosensory and auditory evoked potentials. Performing surgery soon after the hemorrhage minimizes the risk of additional postoperative neurological deficit, since surgical excision is facilitated when the hematoma is not completely organized. Pontine hemangiomas are approached via the 4th ventricle. Mesencephalic hemangiomas are removed by a midline supracerebellar approach when they are lateralized by using a subtemporal approach. The lesion can be removed through a small incision in the brain stem at the site of the lesion. The favorable results, which include marked improvement of preoperative neurological deficits and documentation of complete removal of the lesion by magnetic resonance imaging, support a more aggressive approach to the treatment of symptomatic cavernous hemangiomas of the brain stem. Further investigation of the natural history of these lesions is mandatory.

Surgical removal of pontomesencephalic cavernous hemangiomas

Cavernous hemangiomas of the brain stem are usually discovered accidentally during evacuation of a hematoma, and successful surgical treatment of these lesions is seldom achieved. With the increasing use of magnetic resonance imaging, the presence of a cavernous hemangioma can be detected before surgery, allowing an elective surgical approach. We successfully removed pontomesencephalic cavernous hemangiomas from 2 patients and pontomedullary hemangiomas from 2 others. Elective surgery was performed with perioperative bimodal monitoring of somatosensory and auditory evoked potentials. Performing surgery soon after the hemorrhage minimizes the risk of additional postoperative neurological deficit, since surgical excision is facilitated when the hematoma is not completely organized. Pontine hemangiomas are approached via the 4th ventricle. Mesencephalic hemangiomas are removed by a midline supracerebellar approach when they are lateralized by using a subtemporal approach. The lesion can be removed through a small incision in the brain stem at the site of the lesion. The favorable results, which include marked improvement of preoperative neurological deficits and documentation of complete removal of the lesion by magnetic resonance imaging, support a more aggressive approach to the treatment of symptomatic cavernous hemangiomas of the brain stem. Further investigation of the natural history of these lesions is mandatory.

Hepatic Hemangioma With Normal Angiograms

Three cases of symptomatic cavernous hemangioma of the liver are reported. All three patients have normal angiograms. A review of the literature shows that the diagnosis of hemangioma may be made noninvasively with a high degree of accuracy. Technetium Tc 99m-labeled red blood cell scanning is very specific, while dynamic computed tomography may be more sensitive for small lesions. A combination of the two modalities makes the diagnosis in greater than 90% of cases. Magnetic resonance imaging is also sensitive and specific. Angiography, as shown in these cases, may not only be questionably indicated, but may be misleading. The treatment for symptomatic lesions is resection, and secondary alternatives are discussed.

Disseminated Intravascular Coagulation After Surgical Excision of Cavernous Hemangioma

This report describes the clinical course of a child who had excision of several symptomatic cavernous hemangiomas. Disseminated intravascular coagulation resulted in severe postoperative bleeding. DIC was treated successfully with heparin.