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Case Reports
. 2018 Nov 30;10(11):e3663.
doi: 10.7759/cureus.3663.

Endoscopic Endonasal Surgery for the Resection of a Cavernous Hemangioma with a Sellar Extension

Nicolas K Khattar  1 , Shawn Wc Adams  1 , Alexandra S Schaber  1 , Andrew C White  2 , Mohammed Al Ghamdi  3 , Rob T Hruska  1 , Jesse J Savage  4 , Richard K Downs  2 , Eyas M Hattab  3 , Brian J Williams  1
Affiliations
Case Reports

Endoscopic Endonasal Surgery for the Resection of a Cavernous Hemangioma with a Sellar Extension

Nicolas K Khattar et al. Cureus. .

Abstract

Cavernous hemangiomas with an intrasellar extension are very rare, generally benign lesions that manifest by the compression of nearby structures. The presenting symptoms usually range from visual disturbances to an endocrine imbalance. Occasional extension into the cavernous sinus has been reported, which can cause cranial nerve compression. We present the case of a 69-year-old man presenting with facial pain and decreased libido. On investigation, a lesion was identified and the parasellar region was homogeneously hyper-intense on gadolinium-enhanced magnetic resonance imaging (MRI). Endoscopic endonasal surgery remains one of the favored approaches for the resection of sellar lesions. Such pathology needs to remain on the neurosurgeon's differential diagnosis, making an intraoperative frozen section of these lesions a useful tool in the surgeon's armamentarium, to guide further surgical resection.

Keywords: cavernous hemangioma; endoscopic endonasal surgery; sellar lesion.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Gross total resection of the sellar cavernous hemangioma
Upper: Preoperative axial, coronal, and sagittal T1-weighted MRI studies obtained after the administration of Gd, demonstrating a sellar contrast-enhancing recurrent mass measuring 2.7 cm x 1.9 cm x 1.6 cm extending into the left cavernous sinus Lower: Postoperative axial, coronal, and sagittal T1-weighted MRI studies obtained after gross total resection with EES. Fat graft was used under the vascularized nasoseptal flap. MRI: magnetic resonance imaging; EES: endoscopic endonasal surgery
Figure 2
Figure 2. Sellar cavernous hemangioma pathological characteristics
A. Low power magnification H&E stain of the hemangioma showing large, cystically dilated vessels with thin walls; B. High power magnification H&E stain; C. Elastin staining with no significant presence of elastin in the vessel walls of the arteries and arterioles of the hemangioma; D. Trichrome stain showing significant associated fibrosis with the hemangioma H&E: haemotoxylin and eosin
See this image and copyright information in PMC

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