Gamma knife surgery for cavernous hemangiomas in the cavernous sinus.
BACKGROUND
Cavernous hemangioma in the cavernous sinus (CS) is a rare vascular tumor. Direct microsurgical approach usually results in massive hemorrhage. Radiosurgery has emerged as a treatment alternative to microsurgery.


OBJECTIVE
To further investigate the role of Gamma Knife surgery (GKS) in treating CS hemangiomas.


METHODS
This was a retrospective analysis of 7 patients with CS hemangiomas treated by GKS between 1993 and 2008. Data from 84 CS meningiomas treated during the same period were also analyzed for comparison. The patients underwent follow-up magnetic resonance imaging at 6-month intervals. Data on clinical and imaging changes after radiosurgery were analyzed.


RESULTS
Six months after GKS, magnetic resonance imaging revealed an average of 72% tumor volume reduction (range, 56%-83%). After 1 year, tumor volume decreased 80% (range, 69%-90%) compared with the pre-GKS volume. Three patients had > 5 years of follow-up, which showed the tumor volume further decreased by 90% of the original size. The average tumor volume reduction was 82%. In contrast, tumor volume reduction of the 84 cavernous sinus meningiomas after GKS was only 29% (P < .001 by Mann-Whitney U test). Before treatment, 6 patients had various degrees of ophthalmoplegia. After GKS, 5 improved markedly within 6 months. Two patients who suffered from poor vision improved after radiosurgery.


CONCLUSIONS
GKS is an effective and safe treatment modality for CS hemangiomas with long-term treatment effect. Considering the high risks involved in microsurgery, GKS may serve as the primary treatment choice for CS hemangiomas.
Chou
Chiang-Wei
CW
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and School of Medicine, National Yang Ming University, Taipei, Taiwan.
Wu
Hsiu-Mei
HM
Huang
Chun-I
CI
Chung
Wen-Yuh
WY
Guo
Wan-Yuo
WY
Shih
Yang-Hsin
YH
Lee
Liang-Shong
LS
Pan
David Hung-Chi
DH
D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006392:Hemangioma, Cavernous / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies