Primary Intraosseous Skull Base Cavernous Hemangioma: Case Report

Abstract

Primary intraosseous cavernous hemangiomas (PICHs) of the skull base are extremely rare tumors. These lesions are most common in the frontal and parietal bones of the calvarium. The authors describe a 40-year-old female who presented with progressive headaches. Serial imaging revealed a contrast-enhancing intraosseous lesion of the lateral body of the sphenoid bone and the greater wing associated with encroachment of the inferior cavernous sinus and mild posterior displacement of the cavernous carotid artery. Follow-up imaging 9 years later revealed slow growth of the lesion. The patient underwent complete excision of the PICH through an extradural frontopolar approach. Pathological examination revealed an intraosseous cavernous hemangioma. PICHs of the skull base can mimic other more common skull base lesions and thus can be difficult to diagnose preoperatively. Diagnosis is usually made at surgery. The authors review the literature regarding the clinical presentation, radiological characteristics, pathological features, and surgical management of PICHs.

Figure 1A

T2–weighted coronal MRI with gadolinium infusion from 1993 demonstrating intraosseous hemangioma in the left sphenoid bone with encroachment on the cavernous sinus and displacement of the cavernous carotid artery.

Figure 1B

T1–weighted coronal MRI with gadolinium infusion from 1993 demonstrating intraosseous hemangioma in the left sphenoid bone with encroachment on the cavernous sinus and displacement of the cavernous carotid artery.

Figure 2A

Axial CT showing characteristic trabeculated “honeycomb” appearance of the left greater wing of the sphenoid, extending inferiorly into the pterygoid plate and superiorly into the lateral wall of the sphenoid sinus.

Figure 2B

Coronal CT showing characteristic trabeculated “honeycomb” appearance of the left greater wing of the sphenoid, extending inferiorly into the pterygoid plate and superiorly into the lateral wall of the sphenoid sinus.

Figure 3A

MRI from 2002 demonstrating intraosseous hemangioma of the left sphenoid with slight enlargement. T1 coronal with gadolinium. An additional left cerebellar hemispheric vascular lesion is also appreciated.

Figure 3B

MRI from 2002 demonstrating intraosseous hemangioma of the left sphenoid with slight enlargement. T1 coronal with gadolinium. An additional left cerebellar hemispheric vascular lesion is also appreciated.

Figure 3C

MRI from 2002 demonstrating intraosseous hemangioma of the left sphenoid with slight enlargement. T1 coronal with gadolinium. An additional left cerebellar hemispheric vascular lesion is also appreciated.

Figure 3D

MRI from 2002 demonstrating intraosseous hemangioma of the left sphenoid with slight enlargement. T2 axial. An additional left cerebellar hemispheric vascular lesion is also appreciated.

Figure 3E

MRI from 2002 demonstrating intraosseous hemangioma of the left sphenoid with slight enlargement. T2 axial. An additional left cerebellar hemispheric vascular lesion is also appreciated.

Figure 3F

MRI from 2002 demonstrating intraosseous hemangioma of the left sphenoid with slight enlargement. T1 axial. An additional left cerebellar hemispheric vascular lesion is also appreciated.

Figure 3G

MRI from 2002 demonstrating intraosseous hemangioma of the left sphenoid with slight enlargement. T1 axial with gadolinium reveals enhancing mass in the left sphenoid. An additional left cerebellar hemispheric vascular lesion is also appreciated.

Figure 4A

Pathological examination demonstrating intraosseous cavernous hemangioma composed of thin–walled vascular channels lined by a single layer of flattened endothelial cells interspersed among bony trabeculae (hematoxylin–eosin).

Figure 4B

Immunohistochemical studies for CD34 showing the vascular spaces lined by strongly immunoreactive endothelium.

Figure 5A

Postoperative axial CT performed one day after surgery showing complete resection of skull base cavernous hemangioma.

Figure 5B

Postoperative coronal CT performed one day after surgery showing complete resection of skull base cavernous hemangioma.