Imaging Features And Microsurgical Treatment Of Cavernous Sinus Hemangiomas

Objective To explore the imaging feature of cavernous sinus hemangioma(CSH)and the curative effect of surgically treated large and giant cavernous sinus hemangioma via intradural or epidural approach.Methods A retrospective study of all patients additted to the First Affiliated Hospital of Soochow University with CSH diagnosed by pathology from Jun.2008 to Dec.2017.18 patients including 12 female and 6 male were enrolled,ranging from 41 to 70 years(mean 56 years)..Ptosis/ocular motility disorders(9 cgses),headache(8 cases),decreased visual acuity(6cases)and facial hyperesthesia(3 cases)were the most common presenting complaints.The imaging datas were collected and analysed with the imaging feature.Patients were divided into two groups:the earlier(Jun.2008 to Dec.2012,7patients)and latter groups(Nov.2013 to Dec.2017,11 patients).In the earlier group,tumor resection via the intradural approach was received in 7 cases.In the latter group,the epidural approach was performed in 11 cases,which included 2 combined approach.Clinical symptoms and signs,radiographic characteristics,operative approach and outcomes of these patients were analyzed.The curative effect were followed up.Results The MRI characteristics including super—hyperintensity lesion on T2WI with a gourd—like,acutilingual appearance infiltration from the parasellar to the sellar regions marked homogeneous,trend——homogeneous enhancement appeared in most cases of cavernous sinus hemangiomas.In the earlier group,total tumor resection was attained in 2 cacses(28'6%),subtotal resection in 2 cases and partial resection in 3 cases.The follow-up period was between 30 and 102 months(mean 61.4 months).The results of last follow-up were as follows:Facial hypoesthesia symptom got partial remission in 1 patients.Decreased visual acuity got obviously improved.Among the 4 patients with ptosis/ocular motility disorders,complete remission was achieved in 2,improvement in 2.The other symptoms mentioned above were all relieved.In the latter group,total tumor resection was attained in 8 cacses(71.8%),subtotal resection in 2 case and partial resection in 1 case.The follow-up period was between 6 and 60 months(mean 28.7 months).The results of last follow-up were as follows:Among the 3 patients with decreased visual acuity got obviously improved in 2 cases,no change in 1(blind preoperatively).Among the 5 patients with ptosis/ocular motility disorders,complete remission was achieved in 2,improvement in 3.The other symptoms mentioned above were all relieved.Conclusions The MRI characteristics including super—hyperintensity lesion on T2WI with a gourd—like or acutilingual appearance infiltration from the parasellar to the sellar regions with marked homogeneous or trend——homogeneous enhancement provides great confidence in diagnosing cavernous sinus hemangiomas.Our experience suggests that surgical treatment of large and giant CSH is a reasonable option,the epidural approach is superior to intradual approach in ways of tumor resection and meurovascular protection.