Kida Y, Kobayashi T, Mori Y
Department of Neurosurgery, Komaki City Hospital, Komaki City, Japan.
Surg Neurol. 2001 Aug;56(2):117-22; discussion 122-3. doi: 10.1016/s0090-3019(01)00537-7.
Cavernous hemangiomas in the cavernous sinus are rare and demonstrate unique clinical courses. Although they rarely cause spontaneous bleeding, serious bleeding is not uncommon during operations. Total eradication of such tumors is very difficult because of the location and intraoperative bleeding. Consequently, alternatives to operative resection have been examined.
Three cases of cavernous hemangiomas in the cavernous sinus, presenting chiefly with ocular signs and facial pain, were treated by radiosurgery using a gamma knife. Two of the patients had been operated on before radiosurgery, while the third patient was diagnosed on the basis of neurological signs as well as radiological findings.
MRI scans at the time of radiosurgery showed tumors in the cavernous sinus with low or iso-intensity on T1-weighted images and high signal intensity on T2-weighted images. All of the tumors intensely enhanced with gadolinium-DTPA. The tumors had diameters of 14 to 28 mm and were treated with a marginal dose of 14 to 17 Gy (mean 15.7 Gy). In the mean follow-up period of 27 months after radiosurgery, all of the tumors decreased in size (PR). Neurologically, none of the patients showed any deterioration, and one demonstrated an obvious improvement in ocular movement.
Radiosurgery for cavernous hemangioma in the cavernous sinus is apparently safe and effective with consistent tumor shrinkage. Therefore, radiosurgery is an excellent alternative to operative intervention and may even replace operative procedures if the tumors are small in diameter or when they recur.
海绵窦海绵状血管瘤较为罕见，具有独特的临床病程。尽管它们很少引起自发性出血，但手术过程中严重出血并不少见。由于肿瘤位置和术中出血，彻底切除此类肿瘤非常困难。因此，人们一直在研究手术切除的替代方法。
3例主要表现为眼部症状和面部疼痛的海绵窦海绵状血管瘤患者接受了伽玛刀放射外科治疗。其中2例患者在接受放射外科治疗前曾接受过手术，而第3例患者是根据神经体征和影像学检查结果确诊的。
放射外科治疗时的MRI扫描显示，海绵窦内的肿瘤在T1加权图像上呈低信号或等信号，在T2加权图像上呈高信号。所有肿瘤在注射钆-DTPA后均有明显强化。肿瘤直径为14至28mm，边缘剂量为14至17Gy（平均15.7Gy）。放射外科治疗后的平均随访期为27个月，所有肿瘤均缩小（PR）。在神经功能方面，所有患者均未出现任何恶化，1例患者眼球运动明显改善。
海绵窦海绵状血管瘤的放射外科治疗显然是安全有效的，肿瘤持续缩小。因此，放射外科是手术干预的极佳替代方法，如果肿瘤直径较小或复发，甚至可能取代手术治疗。
