Radiosurgery for hemangiomas of the cavernous sinus and orbit: Technical case report

OBJECTIVE AND IMPORTANCE: Hemangiomas of neurosurgical interest are histolo gically benign vascular tumors that most often occur in the orbit or cavern ous sinus. Hemangiomas can be diagnosed by their characteristic radiographi c and angiographic appearance and their tendency to bleed excessively durin g attempted removal. Intracranial or intraorbital hemangiomas require treat ment when they become symptomatic. CLINICAL PRESENTATION: We report four hemangioma patients who presented wit h ocular symptoms or signs, such as orbital pain, ophthalmoplegia, proptosi s, or impaired visual acuity. Before our evaluation, two patients had each had incomplete resections aborted because of excessive blood loss, one pati ent had undergone a nondiagnostic transsphenoidal biopsy, and one patient h ad had an unsuccessful embolization. INTERVENTION: All four patients were treated with gamma knife radiosurgery. Tumors received a minimal tumor dose that ranged from 14 to 19 Gy. Follow- up evaluations were performed 6 to 24 months after radiosurgery and reveale d a reduction in tumor volume in three patients and no tumor progression in the fourth. All patients had symptomatic improvement, but one had persiste nt diplopia. CONCLUSION: In this early experience, stereotactic radiosurgery proved to b e an effective management strategy that avoided the potentially serious com plications associated with surgery or embolization of cavernous sinus heman giomas.