The Clinical Therapeutic Strategy For Cavernous Sinus Hemangioma

Cavernous sinus hemangioma is a rare benign tumor in cavernous sinus. It account for approximately 0.4%-2.0% of the cavernous sinus tumors[1-3]. The incidence rate of female is significantly higher than male. The ratio of male and female is 1:5. The adult mainly aged from 40～50. Cavernous sinus hemangioma is an uncommon lesion of vascularity, location within cavernous sinus. Because of the relationship to internal carotid artery, trochlear nerve, ophthalmic branch of trigeminal nerve and abducent nerve, the surgical ablation of the tumor is the difficult point in the department of neurosurgery. During the past decades, major advances have been made in microsurgical techniques for skull base surgery, microdissection and the image of skull base. So the surgery in cavernous sinus is gradually progressive, but there is still a high morbidity and mortality. The multiplicity of anatomical relationship in cavernous sinus and the difficult excision of tumor are the main reason. And it may cause hemorrhage and injury of cranial nerves. Now the total tumor removal and good postoperative quality of life is the target of therapeutic strategy, we should make the decision of surgical extent of resection cautiously, choose the surgical approach properly and pay more attention to the clinical application of the radiotherapy.Objective:To investigate the choice of surgical approach, the method of reducing the injury of blood vessels and nerves and the clinical application of the radiotherapy.Patients and Methods:We retrospectively reviewed the medical records of 13 patients with a Cavernous sinus hemangioma treated at our institution between January 2000 and November 2010. Diagnoses were made on the basis of postoperative pathology.2 patients were men and 11 patients were women (ratio,1:5.5). The ages of these patients in our hospital ranged from 33 to 65 years (mean age,47.6 yr; median age,49 yr). The average pathogenesis in this study was 2 years and 50 days, ranged from 30 days to 10 years. The hospital days of these sufferers ranged from 10 to 50 days (mean,20.7 days). Clinical manifestation of these patients were:headaches (n=9,69.2%), decrease sensation over face (n=6,46.2%), eyeball movement obstacle(n=8,61.5%), visual deterioration and visual field defect of lesion side (n=5,38.5%), blepharoptosis oflesion side (n=2,15.4%). Preoperative performance status of all patients was evaluated using the Karnofsky Performance Scale, and the mean preoperative score was 75.86, ranged from 60 to 90.CT and MRI results were evaluated before surgery for all patients, CTA was performed in 5 case. The tumor size is ranged from 3.3cmto6.5cm.Totally removal of the tumor was performed by microsurgery in all patients on the state of general anesthesia. Surgical approach was globally predicated on the tumor size, the location and the preoperative performance status of patients. Epidural approach in middle cranial fossa was used in 5 patients. The 8 patients underwent craniotomy via modified pterional approach; the tumors were removed through intradural approach.Results:Total tumor removal was achieved in 11 cases (84.6%). Exploratory craniotomy was only used for 2 patients (15.4%) who were admitted in 2000 and 2001. No postoperative death occurred. The postoperative complications included oculomotor paralyses in 5 patients (38.5%) of which there were improved in 3 patients 4 months after surgery. Three patients (23.1%) presented abducent nerve palsy, they were improved when they were discharged. Four patients (30.8%) presented facial paralysis of ipsilateral side, in 3 patients facial paralysis of ipsilateral side improved 3 months after surgery. Because our experience was insufficient between 2000 and 2001, two patients were operated via exploratory craniotomy. Follow-up study was available in 8patients, arranged from2 to 5 years. Three patients of abducent nerve palsy were gradually improved in one year after discharging from hospital. Five patients of oculomotor paralyses recovered in different degrees after two years. Follow-up period of 2 patients with facial paralysis of ipsilateral side were gradually improved. Tumor did not recur in 8 patients during the follow-up period arranged from 2-5 years.Conclusion:①Total surgical removal is the only treatment that may cure this benign tumor, the key point of treatment lies in decreasing intraoperative hemorrhage and lightening the injuries of cranial nerves. According to the relationship of dissection, we can decrease intraoperative hemorrhage and lighten the injuries of cranial nerves.②There are a lot of surgical approaches to remove the cavernous sinus hemangioma, each approach has its advantages and disadvantages. We can choose surgical approach for each patient individualized, according to the comprehend status.③Radiotherapy can effectively control the tumor growth and improve the clinical symptoms.