Cavernous Haemangiomas of the Spinal Cord. A Review of 117 Cases

 The data of 48 studies (published between 1903 and 1996), presenting information of all together 107 patients (108 lesions) regarding pre-treatment clinical and radiological factors, treatment strategies, and the outcome, plus our own experience of nine patients were retrospectively re-analyzed. The prognostic influence of pre-treatment factors was estimated with the chi-square statistics. Clinical evaluation before/after treatment was performed using the Frankel scale. The average bleeding rate was obtained from the ratio of percentage of first bleeding events in the population to the mean age of the population.  There were 47 males and 69 females (aged from twelve to 88 years). Thirty nine percent of the lesions were found in the cervical, 54% in the thoracic (30% upper, 24% lower) and 7% in the lumbar cord. The peak age of presentation was in the fourth decade, the median duration of symptoms was 32 months. Clinical symptoms before treatment were progressive in all cases. Three patterns of clinical presentation could be identified: a) episodes of stepwise clinical deterioration (30%), b) slow progression of neurological decline (41%), c) acute onset with rapid or gradual decline over weeks or months (26%). 58% of the lesions showed clinical or radiological signs of haemorrhage. In 66% of surgical patients (91 efficiently documented cases), clinical improvement was achieved, 28% remained unchanged and 6% deteriorated. Whereas age, sex and lesion location had no influence on the results, duration of symptoms (<three years) correlated significantly to a better outcome (p<0.02).  Surgical management in symptomatic patients is recommended. Once clinical signs caused by the malformation have appeared, the patients tend to experience progressive neurological deterioration.     

Wegener's granulomatosis with unusual cavernous sinus and sella turcica extension

Intracerebral extension of Wegener's granulomatosis (WG) is rare. We present a patient with oculomotor and trochlear nerve palsy with histologically proved WG. An MR examination revealed granulomatous tissue in nasal cavity, paranasal sinuses with meningeal infiltration, and uncommon penetration into cavernous sinus and sella turcica. The MR images before and during pharmacological therapy are presented. Received: 14 July 1998; Revision received: 12 October 1998; Accepted: 13 January 1999     

Efficacy of bleomycin treatment for symptomatic hemangiomas in children

Five children aged 5–19 years had pain in massive, inoperable hemangiomas. They were treated with intralesional injections of 2 mg bleomycin as a 0.4 mg/ml solution in the painful area. The injections were repeated after 4-6 weeks for a total of 6–10 times. All children were relieved of pain, and the swelling was reduced in all cases. There were no complications or side effects. Bleomycin therapy of painful, massive hemangiomas can be recommended in older children.     

前外侧或外侧硬脑膜外入路切除海绵窦区肿瘤：附9例临床经验

背景与目的：目前对海绵窦区肿瘤的手术治疗仍是神经外科的难题之一。本文旨在提高海绵窦区肿瘤的全切率，降低神经功能的残障率。方法：针对海绵窦外侧壁的显微解剖特点，结合典型病例分析，回顾性总结了9例海绵窦内肿瘤，经前外侧或外侧硬膜外入路，通过显微神经外科技术切开海绵窦外侧壁夹层，按神经走行方向切开，辨认肿瘤生长和颅神经的关系分块切除肿瘤。结果：9例海绵窦内肿瘤中，海绵状血管瘤1例，神经鞘瘤6例，脑膜瘤2例。全切除5例，3例次全切除，1例大部分切除。3例出现新的颅神经功能障碍症状，6个月后新出现的颅神经功能障碍症状减轻2例．完全恢复1例。结论：明确的海绵窦区显微外科解剖概念．娴熟的显微神经外科技术以及选择适当的手术入路是提高海绵窦区肿瘤的全切率，降低术中出血、术后残障率的关键因素。     

Outcomes of basal ganglia and thalamic cavernous malformation surgery: A meta-analysis

Surgical resection of basal ganglia (BG) and thalamic cavernous malformations (CMs) has not yet become standardized in the field of neurosurgery due to the eloquent location of these lesions and the relative paucity of literature on the subject. This review presents a consolidation of the available literature on outcomes and complication rates after surgical resection of these lesions. A systematic literature review was performed via PubMed database for articles published between 1985 and 2019. Studies comprising ≥2 patients receiving surgery for BG or thalamic CMs with available follow-up data were included. Pooled data included patient demographics, CM preoperative characteristics, and surgical outcomes Twenty studies comprising 227 patients were included for analysis. Complete resection was achieved in 94.7% (fixed-effects pooled estimate [FE]: 94.9%[91.0%–97.8%]; random-effects pooled estimate [RE]: 90.0%[79.8%–96.9%]), and hemorrhage of incompletely resected CMs occurred in 50% (FE: 55.9%[25.9%–83.6%]; RE: 55.9%[25.9%–83.6%]) of patients. Early morbidity was observed in 24.0% (FE: 24.9%[17.8%–32.6%]; RE: 24.9%[17.8%–32.6%]). At final follow-up, 67.3% (FE: 67.7%[58.8%–76.0%]; RE: 67.8%[52.2%–81.6%]) and 20.6% (FE: 20.6%[13.6%–28.6%]; RE: 20.9%[9.8%–34.9%]) had improvement and stability of preoperative symptoms, respectively. Mortality rate was 1.3% (FE: 2.3%[0.6%–5.1%]; RE: 2.3%[0.6%–5.1%]). Therefore, high cure rates with low rates of postoperative morbidity can be achieved in BG or thalamic CM surgery. Most patients had improved neurological function at final follow-up. Complete resection should be attempted to reduce rates of repeat hemorrhage.     

Calvarial bone cavernous hemangioma with intradural invasion: An unusual aggressive course—Case report and literature review

IntroductionCavernous hemangioma of the skull is a rare pathological diagnosis, accounting for 0.2% of bone tumors and 7% of skull tumors. Usually calvarial bone cavernous hemangioma are associated with a benign clinical course and, despite their enlargement and subsequent erosion of the surrounding bone, the inner table of the skull remains intact and the lesion is completely extracranial.Presentation of a caseThe authors present the unique case of a huge left frontal bone cavernous malformation with intradural extension and brain compression determining a right hemiparesis.DiscussionCalvarial cavernous hemangiomas are benign tumors. They arise from vessels in the diploic space and tend to involve the outer table of the skull with relative sparing of the inner table. More extensive involvement of the inner table and extradural space is very unusual and few cases are reported in literature. To the best of our knowledge, intradural invasion of calvarial hemangioma has not been previously reported.ConclusionOur case highlights the possibility of an aggressive course of this rare benign pathology.     

Atypical Presentation of Cavernous Sinus Infection with Intracavernous ICA Aneurysm

In a typical presentation of intracavernous internal carotid artery aneurysm and cavernous sinus infection there is involvement of 3rd, 4th and 6th cranial nerves along with 2nd and 5th cranial nerve. Here we present a case of a 32 years old male with unilateral mycotic intracavernous internal carotid artery aneurysm with a history of head injury. Atypical features in this case was involvement of distantly situated multiple cranial nerves and sparing the 5th cranial nerve and optic nerve which are more near and commonly involved. Besides this patient has marked sphenoid sinusitis on left side but having no sign and symptoms.