Gamma Knife surgery for a hemangioma of the cavernous sinus in a child

Case report

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Cavernous sinus (CS) hemangiomas are rare vascular abnormalities that constitute 0.4%–2% of all lesions within the CS. Cavernous sinus hemangiomas are high-flow vascular tumors that tend to hemorrhage profusely during resection, leading to incomplete resection and high morbidity and mortality. While Gamma Knife surgery (GKS) has proven to be an effective treatment of CS hemangiomas in the adult population, few reports of GKS for treatment of CS hemangiomas exist in the pediatric literature. Here, the authors present the first case of a 15-year-old girl with a biopsy-proven CS hemangioma who achieved complete resolution of her symptoms and a complete imaging-defined response following GKS. If suspicion for a CS hemangioma is high in a pediatric patient, GKS may be considered as an effective treatment modality, thus avoiding the morbidities of open resection.

Abbreviations used in this paper:CN = cranial nerve; CS = cavernous sinus; GKS = Gamma Knife surgery.

Article Information

Address correspondence to: Rory K. J. Murphy, M.D., Barnes-Jewish Hospital, Department of Neurological Surgery, Campus Box 8057, 660 South Euclid Avenue, St. Louis, Missouri 63310. email: murphyr@wudosis.wustl.edu.

Please include this information when citing this paper: published online October 19, 2012; DOI: 10.3171/2012.9.PEDS12213.

© AANS, except where prohibited by US copyright law.

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Figures

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    Serial MR images of the left CS lesion. Coronal T1-weighted images after Gd contrast administration in August (A–C), November (D–F), and December (G–I) of 2009 demonstrating progressive enlargement of a left CS hemangioma (arrowheads) with displacement of the cavernous carotid artery.

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    Photomicrographs obtained from tissue in the left CS indicative of a hemangioma. Staining with CD31 (left) and H & E (right). Original magnification × 40.

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    GammaPlan for treatment of the CS hemangioma. Dynamic planning to avoid radiation injury to optic nerves was also performed.

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    Gadolinium-enhanced coronal MR images obtained 16 months after GKS showing complete resolution of the hemangioma.

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