April 27, 2015
A 47-year-old man without significant clinical history presented to the emergency room for progressive visual disturbances. On examination, a horizontal diplopia worsening in the left lateral gaze was noted.
Cavernous Sinus Hemangioma
- Cavernous sinus hemangiomas (CSHs) are uncommon benign lesions. They account for fewer than 1% of parasellar masses, with a ratio F:M = 7:1, and are seen mainly in the fourth decade of life.
- Symptoms range from headaches and retro-orbital pain to cranial nerve palsies with ophthalmoplegia.
- Key Diagnostic Features:
- CSHs are assessed by MRI, for characterization, location, and relationship with the surrounding structures. The MR image findings are of a well-defined mass with low to isointensity on T1-weighted images, and marked hyperintense signal on T2-weighted images. CSHs show a progressive enhancement with a centripetal fill-in pattern.
- The diagnosis can be confirmed by a labeled red cell blood pool scintigraphy.
- DDx:
- Meningioma
- Chordoma
- Chondroma/chondrosarcoma
- Metastasis
- Swhwannoma
- Lymphoma
- Atypical vascular neoplasm of the cavernous sinus
- Rx: Surgery, preoperative radiation therapy — gamma knife surgery
