Radiosurgery for hemangiomas of the cavernous sinus and orbit: technical case report.
OBJECTIVE
Hemangiomas of neurosurgical interest are histologically benign vascular tumors that most often occur in the orbit or cavernous sinus. Hemangiomas can be diagnosed by their characteristic radiographic and angiographic appearance and their tendency to bleed excessively during attempted removal. Intracranial or intraorbital hemangiomas require treatment when they become symptomatic.


METHODS
We report four hemangioma patients who presented with ocular symptoms or signs, such as orbital pain, ophthalmoplegia, proptosis, or impaired visual acuity. Before our evaluation, two patients had each had incomplete resections aborted because of excessive blood loss, one patient had undergone a nondiagnostic transsphenoidal biopsy, and one patient had had an unsuccessful embolization.


METHODS
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 revealed a reduction in tumor volume in three patients and no tumor progression in the fourth. All patients had symptomatic improvement, but one had persistent diplopia.


CONCLUSIONS
In this early experience, stereotactic radiosurgery proved to be an effective management strategy that avoided the potentially serious complications associated with surgery or embolization of cavernous sinus hemangiomas.
Thompson
T P
TP
University of Pittsburgh School of Medicine and the Center for Image Guided Neurosurgery, Pennsylvania 15213, USA.
Lunsford
L D
LD
Flickinger
J C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D016634:Radiosurgery; D012086:Reoperation