Cavernous hemangioma of the skull: surgical treatment without craniectomy

Case report

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The authors report the case of a large cranial cavernous hemangioma that was treated using embolization and craniotomy with preservation of the outer cranial table. A 3-year follow-up demonstrated no recurrence. Results in this case suggest that cavernous hemangiomas of the cranium may be safely and effectively treated without craniectomy in some cases.

Abbreviations used in this paper: ECA = external carotid artery; MMA = middle meningeal artery.

Article Information

Address correspondence to: Ilya M. Nasrallah, M.D., Ph.D., Department of Radiology, 3400 Spruce Street, Philadelphia, Pennylvania 19104. email address: nasralli@uphs.upenn.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial bone-window CT showing a large, expansile intradiploic mass in the left frontal bone. The lesion is well demarcated from adjacent normal calvaria and shows the coarse, striated trabeculae typical of this tumor.

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    Axial T1-weighted (A), post-Gd T1-weighted (B), T2-weighted (C), and T2-weighted with fat saturation (D) MR images demonstrating displacement of the left cerebral hemisphere but without abnormal signal within the brain parenchyma.

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    Source images from the 3D time-of-flight MR angiography demonstrating the enlarged middle meningeal artery supplying the tumor (arrows).

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    Lateral (left) and anterior (right) left ECA injection angiograms demonstrating the enlarged MMA (arrows) and the dilated vascular channels in the hemangioma.

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    Intraoperative photographs showing the bulging inner table of the craniotomy flap after partial (left) and complete (right) removal of the lesion.

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    Photomicrograph demonstrating typical dilated vascular channels of the resected cavernous hemangioma. Note the stacked embolic material within one of the vascular channels (arrow). H & E, bar = 120 μm.

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    Follow-up head CT obtained 38 months postoperatively, showing an intact left frontal calvaria without evidence of recurrence (arrows).

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