直接穿刺による塞栓術を併用して摘出した頭蓋内髄外海綿状血管腫の2例

抄録

Objective: The current treatment of choice for cavernous hemangioma is surgical resection. However, devastating hemorrhages often make surgical removal difficult. We experienced two cases of intracranial extraaxial cavernous hemangioma totally resected after intralesional injection of n-butyl cyanoacrylate (NBCA).

Case 1: A 76-year-old man presented with a right temporal skin prominence and right extreme exophthalmos. Computed tomography(CT) scan showed that a mass lesion had destroyed the temporal bone and extended to the subcutaneous, the intracranial, and the orbital space. We performed open biopsy to resect a small part of the subcutaneous lesion and encountered considerable bleeding. Pathological examination revealed a cavernous hemangioma. Transarterial embolization and then embolization by percutaneous direct puncture were performed. NBCA diluted with lipiodol widely spread through the lesion. After 4 days, surgery revealed that the lesion was completely embolized and did not bleed at all.

Case 2: A 76-year-old woman presented with bitemporal hemianopsia. Dynamic gadolinium-enhanced magnetic resonance imaging (MRI) and blood pool scintigram revealed a cavernous hemangioma of the cavernous sinus. No tumor stain was detected by cerebral angiogram. We exposed the suprasellar part of the lesion by frontotemporal craniotomy and slowly injected NBCA diluted with lipiodol. Only the suprasellar part compressing the optic chiasm was removed without major bleeding, and the other part was only embolized.

Conclusion: Embolization by percutaneous direct puncture is a safe and effective procedure for the treatment of skull base cavernous hemangioma.