Tabibkhooei A, Fattahi A, Rahatlou H
Neurosurgery, Iran University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2018;44:54-56. doi: 10.1016/j.ijscr.2018.02.019. Epub 2018 Feb 17.
Hemangioblastoma (HB) is a benign vascular tumor that accounts for about 2% of intracranial neoplasms. HB of the cavernous sinus (CS) is extremely rare. Only one report was found in the literature.
We present a 29-year-old female with progressive headache and she had right ptosis and right mild oculomotor nerve palsy. The brain Magnetic Resonance Imaging (MRI) revealed a right extra-axial 4 × 4 cm in right CS position. The patient was operated upon microscopically via sub-temporal approach through a right temporal craniotomy. After the subtotal removal of a highly vascular tumor, the patient was referred for adjuvant therapy with Gamma-knife surgery.
Surgical removal of HB is the most effective treatment of the central nervous system (CNS) HBs. Tumors invading the CS could cause severe bleeding during surgery and HB-because of its vascular origin-had more risk for severe intraoperative bleeding, and in some cases resulted in surgery stop with subtotal resection of tumor.
It was recommended to perform a pre-operative brain angiography and selective embolization of these highly vascular lesions that it could result in subsequent complete surgical removal.
血管母细胞瘤(HB)是一种良性血管肿瘤,约占颅内肿瘤的2%。海绵窦(CS)血管母细胞瘤极为罕见。文献中仅发现一例报告。
我们报告一名29岁女性,患有进行性头痛,伴有右侧上睑下垂和右侧轻度动眼神经麻痹。脑部磁共振成像(MRI)显示右侧海绵窦位置有一个4×4厘米的轴外肿块。患者通过右侧颞部开颅经颞下入路进行显微镜下手术。在次全切除高度血管化肿瘤后,患者接受伽玛刀手术辅助治疗。
手术切除HB是中枢神经系统(CNS)HB最有效的治疗方法。侵犯海绵窦的肿瘤在手术中可能导致严重出血,并且由于HB起源于血管,术中严重出血的风险更高,在某些情况下导致手术因肿瘤次全切除而停止。
建议术前行脑血管造影和对这些高度血管化病变进行选择性栓塞,这可能导致随后肿瘤的完全手术切除。