Cavernous Sinus Hemangioma: Imaging Diagnosis and Surgical Considerations

BACKGROUND: Cavernous sinus hemangiomas (CSHs) are extraaxial vascular malformations that tend to bleed during surgery. METHODS: We reviewed 12 magnetic resonance imaging scans with CSH, 5 of them biopsy proven. RESULTS: In our review, CSH commonly presented as a lobulated mass with high, uniform signal intensity on T2-weighted images, a dumbbell shape, and a sellar extension. Two thirds presented a "filling-in" pattern of enhancement on dynamic imaging. These features should lead to a correct preoperative diagnosis, which is essential for surgical planning and avoiding hemorrhagic complications. CONCLUSIONS: A combination of low signal on T1, high signal on T2 and fluid-attenuated inversion recovery, no diffusion restriction and homogenous enhancement should place CSH at the top of the list of differential diagnoses. This is especially true when there is a "filling-in" pattern on dynamic or delayed imaging. Doing so may alert surgeons to the possibility of copious intraoperative bleeding and therefore avoid complications of hemorrhage.