Esteves Cristiano, Berhanu David, Guerreiro Carla
Neurological Imaging Department, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.
Neurological Imaging Department, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Instituto de Anatomia, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
World Neurosurg. 2025 Feb;194:123440. doi: 10.1016/j.wneu.2024.11.023. Epub 2024 Dec 5.
We describe a case of a 57-year-old woman presenting initially with diplopia who later developed retro-orbital and retroauricular pain. Examination showed right abducens nerve palsy and subsequent right trigeminal nerve hyperesthesia. Neuroimaging revealed a well-defined mass confined to the right cavernous sinus, with high T2 signal intensity and homogeneous enhancement on postgadolinium T1-weighted images. A meningioma was initially considered as the most likely diagnosis. The lesion grew over months, extending into the Meckel's cave and the pituitary fossa. Dynamic T1-weighted images revealed striking and progressive centripetal enhancement, leading to a revised diagnosis of cavernous sinus hemangioma (CSH). CSH is a rare benign extra-axial tumor, which is highly vascularized, and is frequently misdiagnosed as meningioma or schwannoma. The combination of very high T2 signal intensity and progressive centripetal contrast enhancement highly suggest CSH diagnosis. Given the significant risk of bleeding and mortality associated with surgical intervention, it is crucial to recognize CSH preoperatively to plan a meticulous surgical approach.
我们描述了一例57岁女性患者，最初表现为复视，随后出现眶后和耳后疼痛。检查显示右侧展神经麻痹及随后的右侧三叉神经感觉过敏。神经影像学检查发现一个边界清晰的肿块，局限于右侧海绵窦，在钆增强T1加权图像上呈高T2信号强度且均匀强化。最初考虑最可能的诊断为脑膜瘤。该病变在数月内逐渐增大，延伸至 Meckel腔和垂体窝。动态T1加权图像显示显著且进行性的向心性强化，从而修正诊断为海绵窦血管瘤（CSH）。CSH是一种罕见的良性轴外肿瘤，血管高度丰富，常被误诊为脑膜瘤或神经鞘瘤。极高的T2信号强度和进行性向心性对比增强高度提示CSH的诊断。鉴于手术干预存在显著的出血风险和死亡率，术前识别CSH以规划细致的手术方法至关重要。
