Treatment Of Cavernous Sinus Cavernous Hemangioma With Gamma Knife Radiosurgery: Shanghai Experience

Keywords: cavernous hemangioma, gamma knife, cavernous sinus, radiosurgery, outcome

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       Cavernous Sinus Cavernous Hemangioma (CSCH) is a rare disorder which primarily occurred in cavernous sinus and is easily confused with other disorders in the same location. Microsurgery was not a very optimal choice to remove CSCH totally because of massive bleeding and severe damages to cranial nerves in operations.
     Some case studies reported Gamma knife radiosurgery (GKR) was an effective means for the clinical control of CSCH. But there were still no large sample studies to review the characteristics of CSCH.
     We retrospectively reviewed 28 patients whom were treated in our centre from 1996 to 2009. They took 0.2% of all cases we treated during the same period. 46.4% cases were confirmed by pathological diagnosis, the others were diagnosed by neuroimage (contrasted MRI). The average age was 51.0±12.2yr (mean ± SD); female-to-male ratio was 3:1; the three most common symptoms were diplopia, headache, blepharoptosis.
     The average maximal diameter of treatment volumes was 35.2±12.9mm, the average peripheral dose delivered was 13.0±2.2Gy, the average isodose was set at 40.1%±19.3% depending on the size of CSCH. All patients were performed MRI studies every 6 months after GKR. The symptoms and signs were recorded again at the end of the follow-up.
     The average shrinkage rate at the 6th month was 33.5±12.4% and was 38.9±24.2% at the 12th month. All CSCHs were controlled at the end of follow-up without enlargement of volumes. The improvement of symptoms were observed in 78.9% patients without operation history (1 patient was diagnosed accidentally in a routing health examination), and the improvement rate was only 30.8% in patients with operation history (P <0.05).CSCH mainly affected female population around 50 years old, but there is no evidences which can prove CSCH is connected with menopause. The increasing case numbers with age may imply CSCH is a disorder connected with female cavernous sinus development and genetic factors. CSCH can arise from all parts of cavernous sinus and develop relatively slowly. GKR can control CSCH very effectively without new neurological malfunctions. CSCH may arise from a cavernous sinus vascular malformation mimicking AVM which also responses to GKR positively. Although we did not find a statistical connection between GKR dose and CSCH shrinkage rate, we found a positive relation between them. This may imply a staged radiosurgery strategy will be an optimal choice to control huge CSCHs. A good outcome of radiosurgery may be one of the diagnosis standards in patients without pathological diagnosis. GKR can be used as the first line treatment of CSCH instead of traditional neurosurgical operations.
     This is a retrospective study.
     CSCH is a female dominant disorder with slow growing rate and slight neurological malfunction.
     The traditional open surgery may cause severe side effects and massive bleeding, while GKR may control CSCH effectively and shrink it constantly.


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