gms | German Medical Science

Objective: Cavernous haemangiomas located within the cavernous sinus (CSCH) are rare vascular tumours. Total surgical resection may be difficult due to intraoperative bleeding or potential cranial nerve injury. Current treatment modalities for symptomatic CSCH include resection, fractionated radiation therapy, or a combination of the two. We report 4 cases of CSCH treated with stereotactic radiosurgery.

Methods: Four patients (2 men, 2 women, age 28, 43, 45 and 60 years) with contrast enhancing tumours in the cavernous sinus and intrasellar invasion who presented with complete or incomplete ophthalmoplegia, facial pain and headache were treated with gamma knife radiosurgery. The CSCH were diagnosed by open biopsy in one case and in two by its characteristic radiographic and angiographic appearance. In the third patient, the tumour was resected incompletely with histopathological confirmation of the diagnosis and now regrowing tumour. Follow-up clinical and radiographic evaluations were performed 18 months to 5 years after radiosurgery.

Results: All tumours exhibited a marked hyperintensity on T2-weighted images, which helped to distinguish them from most of the meningiomas. After radiosurgery all patients showed a significant reduction in tumour volume at the early follow-up examinations. All presented an obvious symptomatic improvement, no clinical deterioration occurred.

Conclusions: Preliminary results indicate gamma knife radiosurgery for CSCH as safe and effective. Radiosurgery can be performed after partial resection or biopsy and may be the initial treatment for patients with small CSCH if the diagnosis can be anticipated based on neuroimaging.