Extra-axial cavernous hemangioma: Two case reports

Two patients with extra-axial cavernous hemangioma who presented with heada che and oculovisual disturbances were investigated with computed tomography and magnetic resonance imaging. The lesions masqueraded as basal meningiom a, but this diagnosis was not supported by magnetic resonance spectroscopy in one patient. Cerebral angiography with embolization was indicated in one patient, but embolization was not justified in the other. Both patients un derwent a pterional craniotomy. The lesions were extradural and highly vasc ular, necessitating excessive transfusion in one patient in whom gross tota l resection was achieved, and precluding satisfactory removal in the other. There was no mortality Transient ophthalmoplegia, the only complication in one patient, was due to surgical manipulation of the cavernous sinus; it r esolved progressively over 3 months. Extra-axial skull base cavernous heman giomas are distinct entities with clinical and radiological characteristics that differ from those of intraparenchymal cavernous malformations. They c an mimic meningiomas or pituitary tumors. In some cases, magnetic resonance spectroscopy may narrow the differential diagnoses. Surgical resection rem ains the treatment of choice, facilitated by preoperative embolization to r educe intraoperative bleeding and by the application of the principles of s kull base surgery. Fractionated radiotherapy is an alternative in partial o r difficult resections and in high-risk and elderly patients.