EXTRACEREBRAL CAVERNOUS ANGIOMAS OF THE CAVERNOUS SINUS IN THE MIDDLEFOSSA

BACKGROUND Intracranial extracerebral cavernous angiomas (ECCAs) share the same histologic features as intracerebral lesions, but their clin ical picture is different. Surgical treatment of ECCAs of the cavernou s sinus remains a challenge for the neurosurgeon because of a high mor tality and morbidity due to uncontrollable and massive hemorrhage. MET HODS We have experienced seven patients with ECCAs of the cavernous si nus between 1982 and 1994. All cases were verified histologically duri ng surgery and two were totally resected during the first surgical att empt. Six of seven patients were female. The mean age at diagnosis was 54.5 years (range: 43 to 71 years). RESULTS Computed tomography showe d a round or dumbbell-shaped mass in the area of the cavernous sinus. Magnetic resonance imaging revealed a low to isointense mass lesion on the T-1-weighted image, which then showed extremely high intensity on the T-2-weighted image. Only one of our patients showed a minimal amo unt of vascular staining on angiography. The total excision of these m alformations was difficult because intraoperative bleeding could be pr ofuse. In one case, radiation therapy induced a reduction in the size of the tumor after failure of surgical removal. CONCLUSIONS In plannin g surgical strategy for ECCAs, cave should be taken to control the mas sive bleeding. Radiation therapy is helpful to suppress the tumor grow th.