Srinivasan Visish M, Karas Patrick J, Sen Anish N, Fridley Jared S, Gopinath Shankar P
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
World Neurosurg. 2016 Jul;91:672.e1-3. doi: 10.1016/j.wneu.2016.04.009. Epub 2016 Apr 9.
Primary intraosseous calvarial hemangiomas (PICHs) are generally rare and predominate (3:1) in women. Occurrence in the frontal and parietal bones is most common, but involvement of the occipital bone is exceedingly rare, representing 3 of 125 cases in a series of PICHs studied by Heckl et al. in 2000. Histopathology establishes the diagnosis of cavernous hemangioma, which represents the most common subtype of intraosseous hemangiomas. Others include sclerosing, cellular, and capillary. When they do occur in the calvarium, they are most often asymptomatic and discovered incidentally or due to a palpable defect in the skull.
In this case, a calvarial hemangioma was found to be the cause of elevated intracranial pressure in a 35-year-old woman. Resection of the hemangioma and reconstruction of the calvarium provided a complete cure for her symptoms.
Primary intraosseous hemangiomas are rarely symptomatic but must be considered in the differential for calvarial lesions as part of safe surgical planning. Formulating an accurate differential diagnosis by acquiring proper imaging studies and specifically recognizing the classical "starburst" appearance, as well as considering the highly vascular pathology to avoid excess blood loss, is important. This unique case of a hemangioma-induced venous sinus compression and subsequent elevated intracranial pressure illustrates that hemangiomas can arise from any part of the calvarium and cause a wide variety of clinical symptoms.
原发性颅骨内血管瘤（PICHs）通常较为罕见，女性居多（比例为3:1）。最常见于额骨和顶骨，但枕骨受累极为罕见，在2000年Heckl等人研究的一系列PICHs病例中，125例中有3例枕骨受累。组织病理学可确诊海绵状血管瘤，这是骨内血管瘤最常见的亚型。其他类型包括硬化型、细胞型和毛细血管型。当它们发生在颅骨时，通常无症状，多为偶然发现或因颅骨可触及的缺损而被发现。
在本病例中，一名35岁女性的颅骨血管瘤被发现是颅内压升高的原因。切除血管瘤并重建颅骨使她的症状完全治愈。
原发性骨内血管瘤很少有症状，但在安全的手术规划中，作为颅骨病变鉴别诊断的一部分必须予以考虑。通过进行适当的影像学检查并特别识别典型的“星爆”外观来做出准确的鉴别诊断，以及考虑到高度血管化的病理特征以避免过多失血，这很重要。这例由血管瘤导致静脉窦受压并随后引起颅内压升高的独特病例表明，血管瘤可起源于颅骨的任何部位并引起多种临床症状。
