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Vol. 20. Issue 5.
Pages 461-466 (January 2009)
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Vol. 20. Issue 5.
Pages 461-466 (January 2009)
Hemangioma gigante del seno cavernoso. Caso clínico
Giant cavernous sinus haemangioma. Case report
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1896
M. Navas
, M. Pedrosa-Sánchez, P. Martínez-Flórez, R. Carrasco, J.M. Pascual, R.G. Sola
Servicio de Neurocirugía. Hospital Universitario de la Princesa. Madrid
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Resumen
Introducción

El hemangioma intracraneal es una tumoración vascular benigna que raramente afecta al seno cavernoso, por lo que es frecuentemente diagnosticado de forma errónea como meningioma.

Caso clínico

Presentamos el caso de una mujer de 60 años que debutó con un cuadro de parálisis subaguda del tercer par craneal izquierdo. En neuroimagen, se evidenció una masa extraaxial localizada en la fosa craneal media, con extensión a las regiones selar y supraselar, e intenso realce homogéneo tras la administración de contraste. La arteriografía mostró discreto realce en fase arterial y venosa, y efecto de masa. Se realizó una embolización del tronco meningohipofisario izquierdo.

Intervención y evolución

Se practicó una resección subtotal del tumor mediante un abordaje pterional izquierdo, persistiendo un pequeño resto intraselar. El diagnóstico anatomopatológico fue hemangioma. Tras la intervención la paciente no presentó nuevos déficits neurológicos.

Conclusión

El hemangioma debe ser tenido en consideración al realizar el diagnóstico diferencial de los tumores que afectan al seno cavernoso. Su tratamiento constituye un reto quirúrgico para el neurocirujano, dada la complejidad de esta región anatómica y la gran tendencia del tumor a sangrar durante su disección.

Palabras clave:
Hemangioma
Seno cavernoso
Summary
Introduction

Intracranial haemangioma is a benign vascular tumor which seldom affects the cavernous sinus region, being it frequently misdiagnosed as a meningioma.

Case report

A 60-year-old woman presented with a subacute-onset third cranial nerve palsy. A giant extraaxial mass located in the middle cranial fossa which extended into the selar and supraselar areas was diagnosed. It showed homogeneous enhancement after contrast administration. The angiography revealed mild enhancement as well as indirect signs of mass effect, and a tumoral embolization was performed. Surgery and outcome. The tumor was partially removed through a left pterional approach, leaving an intraselar remnant. The patient had an uneventful postoperative course, and did not present new neurological deficits.

Conclusions

The haemangioma must be considered in the differential diagnosis of cavernous sinus tumours. This entity represents a neurosurgical challenge, due to the complexity of this anatomical region and the trend of the tumour to bleed during its dissection.

Key words:
Haemangioma
Cavernous sinus

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