Intracranial contrast-enhancing masses in infants with capillary haemangioma of the head and neck: intracranial capillary haemangioma?

Contrast-enhancing intracranial masses are rarely found in infants with ext racranial capillary haemangiomas (CH). We aimed to assess their nature and progression in three patients undergoing CT and/or MRI. The changes in size of both extra- and intracranial lesions were recorded. In a fourth case, a single examination was obtained. All patients harboured one or two enhanci ng intracranial nodular, meningeal-based lesions. Diffuse leptomeningeal en hancement of the cerebellar surface was also seen in one, which disappeared at follow-up. In all but one of the cases, the intracranial lesions were o n the same side as the extracranial CH. These lesions and the extracranial CH demonstrated parallel changes in size (suggesting that both represent CH ) during follow-up of 1-2 years: the size of intracranial lesions and the e xtracranial CEI decreased in two cases, whereas it was unchanged in the thi rd. One patient had a persistent trigeminal artery, while another had cereb ellar atrophy with high signal in the cortex on T2-weighted images. In some cases, extracranial CH are part of PHACE syndrome; the association with in tracranial CH might represent a peculiar phenotype of this rare vascular ph akomatosis. As extracranial CH are known to regress spontaneously in the ma jority of cases, a conservative approach is recommended also for presumed i ntracranial CH; surgery should be avoided unless follow-up studies demonstr ate growth.