Brichacek Michal, Naeem Abdul, Filler Guido, Hammond Robert, Yazdani Arjang, Ranger Adrianna
Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba.
Department of Neurosurgery.
J Craniofac Surg. 2018 Sep;29(6):1625-1628. doi: 10.1097/SCS.0000000000004613.
The authors describe a case of congenital calvarial hemangioma successfully managed using propranolol therapy. Presenting symptoms, radiological and pathological features, differential diagnosis, and management of this rare congenital mass are described.
A 2-year-old boy presented with a 1-year history of a growing right parietal skull mass. No obvious etiology was apparent. No focal neurological deficits or associated craniofacial anomalies were identified. Plain film imaging demonstrated focal thickening of the right parietal bone with internal trabeculations in a sunburst appearance. Computed tomography (CT) scan showed bone thickening with coarsening of the bony trabeculae, minor irregularity of the outer table, unaffected inner table, and no evidence of aggressive features. A diagnostic biopsy of the lesion was performed in the operating room. Microscopic examination was consistent with hemangioma. Based on histological and radiological features of the lesion, it was identified as a cavernous hemangioma. Medical treatment utilizing propranolol was initiated for over 3 years with interval reduction in the lesion size. MRI head following treatment with propranolol demonstrated reduction of the mass compared to preoperative imaging.
Although a rare entity, it is important to consider congenital calvarial hemangioma in the differential diagnosis of slow growing skull lesions due to the possibility of complications as a result of the hemangioma's intracranial extension, and the potential for treatment. En bloc resection has classically been described as a treatment for such lesions, although our case demonstrates that medical treatment with propranolol therapy may be appropriate in certain situations.
作者描述了一例使用普萘洛尔治疗成功的先天性颅骨血管瘤病例。描述了该罕见先天性肿块的临床表现、影像学和病理学特征、鉴别诊断及治疗方法。
一名2岁男孩，右顶骨肿块生长1年。未发现明显病因。未发现局灶性神经功能缺损或相关颅面畸形。平片显示右顶骨局限性增厚，内部小梁呈放射状排列。计算机断层扫描（CT）显示骨质增厚，骨小梁增粗，外板轻度不规则，内板未受影响，无侵袭性特征。在手术室对病变进行了诊断性活检。显微镜检查结果与血管瘤一致。根据病变的组织学和影像学特征，确定为海绵状血管瘤。使用普萘洛尔进行药物治疗3年多，病变大小逐渐缩小。普萘洛尔治疗后头部MRI显示肿块较术前影像学检查有所缩小。
尽管先天性颅骨血管瘤是一种罕见疾病，但在鉴别诊断生长缓慢的颅骨病变时，考虑到血管瘤颅内扩展可能导致的并发症以及治疗的可能性，将其纳入鉴别诊断很重要。整块切除一直是此类病变的经典治疗方法，尽管我们的病例表明，在某些情况下，普萘洛尔药物治疗可能是合适的。
