Haber Jessica S, Kesavabhotla Kartik, Ottenhausen Malte, Bodhinayake Imithri, Dinkin Marc J, Segal Alan Z, Lee Young M, Boockvar John A
Departments of Neurological Surgery.
J Neurosurg. 2014 Jun;120(6):1309-12. doi: 10.3171/2014.3.JNS131756. Epub 2014 Apr 11.
Cavernous sinus cavernous hemangiomas in pregnancy are extremely rare lesions. The precise management of these lesions remains unknown. The authors present a case of a cavernous hemangioma in pregnancy, centered within the cavernous sinus that underwent postpartum involution without surgical intervention. A 34-year-old pregnant patient (gravida 1, para 0) presented to an otolaryngologist with persistent headache and left-sided facial pain and numbness in the V1 distribution. While being treated for sinusitis, her symptoms progressed to include a left-sided oculomotor palsy and abducens palsy. Magnetic resonance imaging without contrast revealed an expansile mass within the left cavernous sinus consistent with a cavernous hemangioma. The patient was evaluated by a neurosurgeon who recommended close follow-up and postpartum imaging without surgical intervention. Although the lesion enlarged during pregnancy, the patient was able to undergo an uncomplicated cesarean section at 37 weeks. All facial and ocular symptoms resolved by 9 months postpartum, and MRI showed a decrease in lesion size and reduced mass effect. The authors conclude that nonsurgical management may be a viable approach in patients who have an onset or exacerbation of symptoms associated with cavernous sinus cavernous hemangiomas during pregnancy because postpartum involution may negate the need for surgical intervention.
孕期海绵窦海绵状血管瘤是极为罕见的病变。这些病变的确切治疗方法尚不清楚。作者报告了一例孕期海绵状血管瘤病例，病变位于海绵窦内，产后未经手术干预自行消退。一名34岁的孕妇（孕1产0）因持续性头痛、左侧面部疼痛以及V1分布区的麻木感就诊于耳鼻喉科医生。在治疗鼻窦炎期间，她的症状进展为包括左侧动眼神经麻痹和展神经麻痹。无对比剂的磁共振成像显示左侧海绵窦内有一膨胀性肿块，符合海绵状血管瘤表现。神经外科医生对该患者进行了评估，建议密切随访并在产后进行影像学检查，无需手术干预。尽管病变在孕期增大，但患者在37周时顺利进行了剖宫产。产后9个月时，所有面部和眼部症状均消失，MRI显示病变大小减小且占位效应减轻。作者得出结论，对于孕期出现与海绵窦海绵状血管瘤相关症状发作或加重的患者，非手术治疗可能是一种可行的方法，因为产后病变自行消退可能使手术干预不再必要。
