Conservative management of cavernous sinus cavernous hemangioma in pregnancy

2014 ◽  
Vol 120 (6) ◽  
pp. 1309-1312 ◽  
Author(s):  
Jessica S. Haber ◽  
Kartik Kesavabhotla ◽  
Malte Ottenhausen ◽  
Imithri Bodhinayake ◽  
Marc J. Dinkin ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cavernous Hemangioma ◽  
Surgical Intervention ◽  
Pregnant Patient ◽  
Mass Effect ◽  
Lesion Size ◽  
Nonsurgical Management ◽  
Postpartum Involution ◽  
Cavernous Hemangiomas ◽  
In Pregnancy

Cavernous sinus cavernous hemangiomas in pregnancy are extremely rare lesions. The precise management of these lesions remains unknown. The authors present a case of a cavernous hemangioma in pregnancy, centered within the cavernous sinus that underwent postpartum involution without surgical intervention. A 34-year-old pregnant patient (gravida 1, para 0) presented to an otolaryngologist with persistent headache and left-sided facial pain and numbness in the V1 distribution. While being treated for sinusitis, her symptoms progressed to include a left-sided oculomotor palsy and abducens palsy. Magnetic resonance imaging without contrast revealed an expansile mass within the left cavernous sinus consistent with a cavernous hemangioma. The patient was evaluated by a neurosurgeon who recommended close follow-up and postpartum imaging without surgical intervention. Although the lesion enlarged during pregnancy, the patient was able to undergo an uncomplicated cesarean section at 37 weeks. All facial and ocular symptoms resolved by 9 months postpartum, and MRI showed a decrease in lesion size and reduced mass effect. The authors conclude that nonsurgical management may be a viable approach in patients who have an onset or exacerbation of symptoms associated with cavernous sinus cavernous hemangiomas during pregnancy because postpartum involution may negate the need for surgical intervention.

Cavernous Hemangioma of the Cavernous Sinus, Skin, and Retina: Hemodynamic Changes after Treatment: Case Report

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. E952-E952 ◽  
Author(s):  
M. Javad Mirzayan ◽  
H. Holger Capelle ◽  
Alexandru C. Stan ◽  
Friedrich Goetz ◽  
Joachim K. Krauss
Keyword(s):  
Cavernous Sinus ◽  
Cavernous Hemangioma ◽  
Clinical Presentation ◽  
Hemodynamic Changes ◽  
Subsequent Increase ◽  
Parasellar Region ◽  
Cavernous Hemangiomas ◽  
Oculomotor Disturbances ◽  
The Right ◽  
Oculomotor Nerves

Abstract OBJECTIVE There are several reports concerning cavernous hemangiomas of the skin and central nervous system. Additional retinal involvement has also been reported. CLINICAL PRESENTATION The authors report a 69-year-old woman with a giant extra-axial cavernous hemangioma of the right cavernous sinus involving the supra- and parasellar region, retina, and skin. INTERVENTION Shrinkage of its cutaneous part lead to subsequent increase of the volume of the intracranial part. Owing to compression of the optic and the oculomotor nerves, oculomotor disturbances, ptosis, and visual impairment to 0.2 occurred. Via a pterional approach microsurgical removal of the tumor except for a remnant of the intracavernous part was performed. CONCLUSION Hemodynamic connection between cutaneous, retinal, and intracranial hemangiomas should be considered.

scholarly journals Intrasellar Cavernous Hemangioma, a Rare Condition Causing Both Radiological And Clinical Difficulties- a Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A589-A590
Author(s):  
Andrzej Jerzy Nowak ◽  
Anna Grochowska ◽  
Dariusz Adamek ◽  
Magdalena Godlewska ◽  
Marcin Motyka ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Cavernous Sinus ◽  
Cavernous Hemangioma ◽  
Histopathological Examination ◽  
Sella Turcica ◽  
Tumor Board ◽  
Oculomotor Nerve Palsy ◽  
Tumor Mass ◽  
Cavernous Hemangiomas

Abstract Introduction: Intrasellar cavernous hemangiomas constitute an extremely rare group of findings in endocrinological practice. Diagnosis remains challenging due to non-characteristic symptoms and neuroradiological features which may resemble those of pituitary adenomas. Presentation of the Case: We present a case of female born in 1941, diagnosed with a hemangioma cavernosum located in the Sella turcica. In 2004 our patient presented with uncharacteristic symptoms: syncopes and chronic headaches. Computed tomography (CT) of the head revealed an intrasellar hyperdense tumor mass with radiological features suggesting a pituitary adenoma. In 2005 the patient underwent transcranial resection of the sellar mass, with subsequent oculomotor nerve palsy. In histopathological examination, diagnosis of cavernous hemangioma was determined. Between 2005 and 2020 patient was asymptomatic, with multiple follow-up head MRIs scans, showing gradual progression in size of the intrasellar tumor. The patient was consulted by a neurosurgeon, with no direct indications for surgical approach found. Furthermore, due to suprasellar expansion into the direct proximity of the right optic nerve, the patient was disqualified for Gamma-Knife radiotherapy. The last MRI of the hypothalamic-pituitary area in 2020 revealed a polycyclic, homogeneous, 33x31x29 mm mass, filling in the space of the Sella turcica, with strong enhancement after contrast administration. Invasion of the surrounding structures, including the clivus, right cavernous sinus and right trigeminal cave were described. Bilaterally, internal carotid arteries and right optic nerve adhered directly to the lesion. Pituitary gland was compressed by the tumor mass. In July 2020, in order to verify the ambiguous radiological and clinical characteristics of the lesion including tumor regrowth and its invasiveness, a transsphenoidal partial resection was performed. Tissue samples were collected for the histopathological examination, which confirmed the initial diagnosis of cavernous hemangioma originating from the cavernous sinus. During a multidisciplinary tumor board, having taken into consideration relatively stable clinical condition and high risk possible surgical complications, the patient was currently disqualified from neurosurgical re-operation nor radiotherapy. Surprisingly, during whole follow up, patients pituitary function remained unimpaired. A watchful waiting approach, with radiological and endocrinological follow up were scheduled. Conclusion: To date, only few cases of intrasellar cavernous hemangiomas have been reported. Intrasellar hemangiomas may originate from the vascular tissue of the cavernous sinus. Surgical removal remains the recommended treatment modality, but radiosurgery could be a therapeutic option as well. Stable patients with no clinical symptoms may remain in observation.

scholarly journals Intrasellar Cavernous Hemangioma: A Case Report and Literature Review

2017 ◽  
Vol 3 (2) ◽  
pp. 111-115
Author(s):  
Xinmin Wu ◽  
Hongquan Yu ◽  
Gang Zhao ◽  
Le Wang ◽  
Yang Liu ◽  
...  
Keyword(s):  
Literature Review ◽  
Cavernous Hemangioma ◽  
Sella Turcica ◽  
Mass Effect ◽  
Transsphenoidal Approach ◽  
Pituitary Fossa ◽  
Cavernous Hemangiomas ◽  
Suprasellar Cistern ◽  
Subtotal Removal ◽  
Specific Symptoms

Intrasellar cavernous hemangioma is rare. There are no specific symptoms and the mass effect often mimics pituitary macroadenoma. We present one case of intrasellar cavernous hemangioma that was misdiagnosed. Progressively decreasing vision was the main symptom in this case. The prolactin level was mildly increased but other biochemistry examinations were normal. Magnetic resonance imaging showed an enlarged pituitary fossa and an irregular solid tumor (33 mm × 22 mm × 22 mm) in the sella turcica and parasellar region. Subtotal removal in the case was performed through a transsphenoidal approach. Postoperatively, the patient's visual acuity improved. Through a literature review of 8 intrasellar cavernous hemangiomas, we found most lesions are likely to extend into the suprasellar cistern and cavernous sinus, and total resection is difficult. Transsphenoidal approach surgery should be applied for decompression of the optic nerve and biopsy, and stereotactic radiosurgery is preferable.

scholarly journals Imaging findings and 4 years follow-up of adrenal cavernous hemangioma: a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Valentina Testini ◽  
Laura Eusebi ◽  
Willy Giannubilo ◽  
Vincenzo Ferrara ◽  
Francesco Bartelli ◽  
...  
Keyword(s):  
Cavernous Hemangioma ◽  
Mass Effect ◽  
Histopathological Diagnosis ◽  
Case Presentation ◽  
First Case ◽  
Appropriate Treatment ◽  
Cavernous Hemangiomas ◽  
Adrenal Masses ◽  
Rule Out

Abstract Background Adrenal hemangioma is a rare and non-functional benign tumor. Since the first case in 1955, approximately 90 cases have been reported in literature frequently presenting as a large and incidentally discovered retroperitoneal mass or as a result of hemorrhage caused by spontaneous rupture. Case presentation A 69-year-old man was admitted to our hospital for right hypocondrium pain and anemia. A computed tomography (CT) scan was performed and a large right adrenal mass measured 18 cm was found. The patient underwent laparoscopic right adrenalectomy. Histopathological diagnosis revealed a cavernous adrenal hemangioma. Conclusion Cavernous hemangiomas are uncommon tumors. We reported a case of adrenal cavernous hemangioma incidentally discovered by ultrasound and CT. In the case of finding adrenal masses, cavernous hemangiomas, although rare, should be considered a possible diagnosis. The appropriate treatment is surgical resection to rule out any potential for malignancy, to relieve symptoms secondary to the mass effect, and to prevent complications such as retroperitoneal bleeding.

Gamma knife radiosurgery for cavernous hemangiomas in the cavernous sinus

2002 ◽  
Vol 97 ◽  
pp. 477-480 ◽  
Author(s):  
Naoki Nakamura ◽  
Masahiro Shin ◽  
Masao Tago ◽  
Atsuro Terahara ◽  
Hiroki Kurita ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Cavernous Hemangioma ◽  
Gamma Knife Radiosurgery ◽  
Vascular Tumor ◽  
Treatment Modalities ◽  
Surgical Removal ◽  
Intraoperative Bleeding ◽  
Content Type ◽  
Cavernous Hemangiomas

✓ A cavernous hemangioma occurring in the cavernous sinus is a rare vascular tumor that causes cranial nerve symptoms by direct compression. Surgical removal is often difficult because excessive intraoperative bleeding is expected. These lesions remain a therapeutic challenge even with state-of-the-art treatment modalities. The authors report three cases of cavernous hemangioma occurring in the cavernous sinus that were treated with gamma knife radiosurgery, with a mean patient age of 66 years and a mean tumor volume of 2.3 cm3.

Management of prolonged epistaxis in pregnancy: case report

2013 ◽  
Vol 127 (8) ◽  
pp. 811-813 ◽  
Author(s):  
K Cornthwaite ◽  
K Varadharajan ◽  
M Oyarzabal ◽  
H Watson
Keyword(s):  
Case Report ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Pregnant Patient ◽  
Evidence Based ◽  
Second Trimester ◽  
Severe Epistaxis ◽  
Life Threatening ◽  
Evidence Based Guidelines ◽  
In Pregnancy

AbstractObjectives:To report a case of life-threatening epistaxis in a pregnant patient, describe the links between pregnancy and epistaxis, and discuss the management of such cases. Life-threatening epistaxis in pregnancy is rare, and there are no specific evidence-based guidelines regarding the management of these patients.Case report:A 31-year-old primigravida presented with severe epistaxis in the second trimester of her pregnancy. Conservative measures failed, thereby necessitating surgical intervention.Conclusion:This case illustrates the importance of a multidisciplinary approach in the management of a pregnant patient presenting with severe epistaxis, and highlights the surgical challenges presented in such a situation.

Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study

2019 ◽  
Vol 31 (2) ◽  
pp. 271-278 ◽  
Author(s):  
Narihito Nagoshi ◽  
Osahiko Tsuji ◽  
Daisuke Nakashima ◽  
Ayano Takeuchi ◽  
Kaori Kameyama ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Surgical Intervention ◽  
Lesion Size ◽  
Sudden Onset ◽  
Neurological Function ◽  
Neurological Injury ◽  
Prognostic Indicators ◽  
Asymptomatic Patients ◽  
Surgical Data ◽  
Unstable Gait

OBJECTIVEIntramedullary cavernous hemangioma (CH) is a rare vascular lesion that is mainly characterized by the sudden onset of hemorrhage in young, asymptomatic patients, who then experience serious neurological deterioration. Despite the severity of this condition, the therapeutic approach and timing of intervention for CH remain matters of debate. The aim of this study was to evaluate the clinical characteristics of CH patients before and after surgery and to identify prognostic indicators that affect neurological function in these patients.METHODSThis single-center retrospective study included 66 patients who were treated for intramedullary CH. Among them, 57 underwent surgery and 9 patients received conservative treatment. The authors collected demographic, symptomology, imaging, neurological, and surgical data. Univariate and multivariate logistic regression analyses were performed to identify the prognostic indicators for neurological function.RESULTSWhen comparing patients with stable and unstable gait prior to surgery, patients with unstable gait had a higher frequency of hemorrhagic episodes (52.4% vs 19.4%, p = 0.010), as assessed by the modified McCormick Scale. The lesion was significantly smaller in patients who underwent conservative treatment compared with surgery (2.5 ± 1.5 mm vs 5.9 ± 4.1 mm, respectively; p = 0.024). Overall, the patients experienced significant neurological recovery after surgery, but a worse preoperative neurological status was identified as an indicator affecting surgical outcomes by multivariate analysis (OR 10.77, 95% CI 2.88–40.36, p < 0.001). In addition, a larger lesion size was significantly associated with poor functional recovery in patients who had an unstable gait prior to surgery (8.6 ± 4.5 mm vs 3.5 ± 1.6 mm, p = 0.011).CONCLUSIONSOnce a hemorrhage occurs, surgical intervention should be considered to avoid recurrence of the bleeding and further neurological injury. In contrast, if the patients with larger lesion presented with worse preoperative functional status, surgical intervention could have a risk for aggravating the functional deficiencies by damaging the thinning cord parenchyma. Conservative treatment may be selected if the lesion is small, but regular neurological examination by MRI is needed for assessment of a change in lesion size and for detection of functional deterioration.

scholarly journals Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Emel Avci ◽  
Burak Ozaydin ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
World Health ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Total Resection ◽  
Who Grade ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously enhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/TMK5363836M

424 Advanced gestational age is a predictor of non-completion of sleep apnea testing in pregnancy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A168-A168
Author(s):  
Mihaela Bazalakova ◽  
Abigail Wiedmer ◽  
Lauren Rice ◽  
Sakshi Bajaj ◽  
Natalie Jacobson ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Gestational Age ◽  
Retrospective Chart Review ◽  
Pregnant Patient ◽  
Clinic Visit ◽  
Early Screening ◽  
Home Sleep Apnea Testing ◽  
Living Children ◽  
Apnea Testing ◽  
In Pregnancy

Abstract Introduction Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. Methods We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. Results The vast majority of referrals (&gt;95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing. Conclusion We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with &gt;50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy. Support (if any) None

Transpalpebral Superolateral Orbitotomy for Orbital Cavernous Hemangioma Extirpation: 2-Dimensional Operative Video

2021 ◽  
Vol 20 (4) ◽  
pp. E300-E300
Author(s):  
Adrien T May ◽  
Ramona Guatta ◽  
Torstein R Meling
Keyword(s):  
Optic Nerve ◽  
Cavernous Hemangioma ◽  
Healthy Woman ◽  
Mass Effect ◽  
Complete Information ◽  
Nerve Compression ◽  
Definitive Treatment ◽  
Vascular Tumors ◽  
Cerebral Magnetic Resonance Imaging ◽  
Patient Consent

Abstract Cavernous hemangiomas of the orbit are low-pressure vascular tumors. Usually benign, they become symptomatic by the local mass effect, pushing the eyeball forward, causing exophthalmia, by oculomotor muscle and nerve compression causing diplopia or by optic nerve compression, leading to visual impairment.  Radiotherapy is of limited value in their treatment because of the fragility of the optic nerve and subsequent blindness risk. Surgery remains the gold standard and definitive treatment. We illustrate in this video a transpalpebral superolateral orbitotomy and extirpation of an orbital cavernous hemangioma.  A 52-yr-old healthy woman was sent for neurosurgical consultation by her ophthalmologist. She described a history of progressive unilateral right exophthalmia in the last months. A cerebral magnetic resonance imaging (MRI) revealed a 2.5-cm-large orbital lesion located superiorly and laterally to the eyeball. Surgery was proposed and accepted by the patient. The frontozygomatic component of the orbital rim needed to be removed to safely extirpate the cavernous hemangioma without exerting unnecessary and risky pressure on the eyeball.1,2 We decided to go for a superolateral orbitotomy via a transpalpebral incision.3 Total removal of the lesion was achieved with no complication. Exophthalmia normalized.  Written patient consent was obtained for use and publication of their image after complete information. The patient consented to the surgery.

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