Clinical Outcome and Technical Nuances After Resection of Orbital Cavernous Venous Malformations-A Single-Center Experience.

BACKGROUND: Cavernous venous malformations (CVMs) represent the most common benign intraorbital lesions. Enlarging or symptomatic CVMs (progressive proptosis or visual disturbances) are treated by surgical resection. For this, a variety of different surgical approaches have been described. The aim of this study was to present a contemporary series of orbital CVMs treated via open microsurgical approaches. METHODS: In this study, patients who underwent resection of orbital CVMs between 2002 and 2019 were included. Presenting symptoms were noted and neuro-ophthalmologic examinations performed pre- and postoperatively. For surgical resection, the location of the orbital CVM and its relation to the orbital anatomy led to decision-making for appropriate approaches. A comparison between anatomical location and surgical outcome was performed. RESULTS: Overall, 35 patients with orbital CVMs were included. Most common presenting symptoms were progressive proptosis (43%) and visual disturbances (34%). Most common location was the lateral quadrant (37%) followed by the superior quadrant (20%). A subfrontal craniotomy was performed in 40% of cases followed by a supraorbital craniotomy including the orbital rim in 34% of cases. For surgical excision, a cryo-probe was used in 30 patients, and complete resection was feasible in all cases. Location of a CVM within the superior quadrant was associated with improved postoperative recovery of visual acuity. No differences for clinical outcomes were observed depending on the surgical approach. CONCLUSIONS: Resection of orbital CVMs is indicated in patients with visual disturbances or progressive proptosis. In these, microsurgical approaches can be used with minimal morbidity for complete removal of these well-circumscribed lesions.

Sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage - case report.

BACKGROUND: We report a rare case of sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage. CASE PRESENTATION: A 45-year-old woman presented decreased visual acuity in both eyes. Her best corrected visual acuity was 0.1 in the right eye and 0.15 in the left eye. Goldmann perimetry showed bilateral central scotomas and bitemporal visual field defects. MRI demonstrated a lesion with mixed hypo- and hyperintensity at the optic chiasm, which was thought to be an intratumoral hemorrhage. The patient underwent bifrontal craniotomy. The tumor was exposed via an anterior interhemispheric approach, and histological evaluation of the mass led to a diagnosis of cavernous angioma. Six months after the surgery, her best corrected visual acuity was 0.9 in the right eye and 0.9 in the left, with slight bitemporal visual field defects. CONCLUSION: Third ventricular cavernous angioma is considered in the differential diagnosis of chiasmal syndrome. Contrast-enhanced MRI and FDG-PET might be useful for differential diagnosis of cavernous angioma from other chiasmal tumors including glioblastoma.

Cavernous Angioma Mimicking Meningioma.

The authors present a rare case of cavernous angioma mimicking a meningioma in a 58-year-old man who presented with a headache and dizziness. There were no neurological deficits or other neurological symptoms or signs. An extra-axial mass lesion thought to be associated with diffusely well-enhanced falx in the postcontrast sections was noted in the posterior interhemispheric fissure near the posterior part of the corpus callosum splenium. Extra-axial cavernous angiomas (cavernomas) are extremely rare lesions. They most commonly occur in the parenchyma but have been occasionally reported to arise from the dura matter. Dural cavernous angiomas arise from dural sinuses, falx cerebri, tentorium cerebelli, cranial base dura, or internal auditory canal dura and convexity. Parenchymal cavernous angiomas classically have a ring of hemosiderin surrounding the lesions observed on magnetic resonance imaging, but dural cavernous angiomas do not display the same magnetic resonance imaging characteristics and occasionally exhibit a dural tail sign due to which they can often be misdiagnosed as meningiomas.

Optic Nerve Meningioma Mimicking Cavernous Hemangioma.

A 38-year-old woman presented with rapidly worsening, painless right monocular vision loss. An examination revealed a visual acuity of 1.4/10 and a central scotoma in the right eye. The orbital magnetic resonance imaging (MRI) showed a well-delineated ovoid intraconal mass of the right eye, hyperintense on T2-weighted MRI with homogenous enhancement after contrast injection. The mass abutted and displaced the optic nerve. A diagnosis of cavernous hemangioma was evoked, which is the most common benign adult orbital mass with these MRI features. A biopsy was performed, and the histopathologic examination yielded a diagnosis of optic nerve sheath meningioma based on a positive antiprogesterone receptor antibody immunostaining. Our case highlights the problem with establishing a specific pathologic diagnosis based on MRI alone, even though the morphologic aspect is evocative. It is recommended to always conduct a histopathologic examination before establishing a specific diagnosis as pathology remains the gold standard, especially when the course of action or treatment may change, as in our case.

Dynamic hub load predicts cognitive decline after resective neurosurgery.

Resective neurosurgery carries the risk of postoperative cognitive deterioration. The concept of 'hub (over)load', caused by (over)use of the most important brain regions, has been theoretically postulated in relation to symptomatology and neurological disease course, but lacks experimental confirmation. We investigated functional hub load and postsurgical cognitive deterioration in patients undergoing lesion resection. Patients (n = 28) underwent resting-state magnetoencephalography and neuropsychological assessments preoperatively and 1-year after lesion resection. We calculated stationary hub load score (SHub) indicating to what extent brain regions linked different subsystems; high SHub indicates larger processing pressure on hub regions. Dynamic hub load score (DHub) assessed its variability over time; low values, particularly in combination with high SHub values, indicate increased load, because of consistently high usage of hub regions. Hypothetically, increased SHub and decreased DHub relate to hub overload and thus poorer/deteriorating cognition. Between time points, deteriorating verbal memory performance correlated with decreasing upper alpha DHub. Moreover, preoperatively low DHub values accurately predicted declining verbal memory performance. In summary, dynamic hub load relates to cognitive functioning in patients undergoing lesion resection: postoperative cognitive decline can be tracked and even predicted using dynamic hub load, suggesting it may be used as a prognostic marker for tailored treatment planning.

Intramedullary cavernoma: A surgical resection technique.

Intramedullary spinal cavernoma is a rare vascular disease constituting 5-12% of all spinal vascular tumors. The clinical course is usually characterized either by an acute neurological deterioration, recurrent episodes of neurological deficits or by a slowly progressive neurological decline. Microsurgical removal is recommended when the symptoms become clinically relevant and the lesion appears accessible. In this article, we present a surgical technique to completely resect an intramedullary cavernoma with the aid of intraoperative electrophysiological monitoring and intraoperative real-time ultrasound guidance. A brief description of current management of this pathology is also presented.

Diffuse Cavernous Hemangioma of the Colon.

A 70-year-old man was admitted to our clinic with a history of rectal bleeding and constipation, his colonoscopy revealed varicosities and bluish nodular lesions of the rectum (Figure 1). Abdominal CT showed multiple nodular lesions beginning from the distal descending colon and extending to the rectum, calcifications suggesting phleboliths were also seen in these lesions. A contrast enhanced pelvic MRI demonstrated multiple tubular lesions showing hyperintensity on T2-weighted images and hypointensity on T1-weighted images, consistent with the affected areas on the CT scan (Figure 2). It was a diffuse cavernous hemangioma, which mostly affects the rectosigmoid colon in the gastrointestinal tract, and can clinically mimic internal hemorrhoids, ulcerative colitis or cancer (1). Gastrointestinal hemangioma is a rare benign vascular neoplasm, and might be associated with a congenital disorder like Osler-Weber-Rendu disease, Maffucci's syndrome, Klippel-Trénaunay syndrome, or the congenital blue rubber bleb nevus syndrome (2). Even though there are different medical treatment options targeting VEGF and FGF-mediated pathways such as bevacizumab and thalidomide, and endoscopic approaches like sclerotherapy and electrocautery; complete resection of the hemangioma is the only curative treatment method (1, 3). Therefore, the patient was referred to department of surgery for a definitive treatment, and lost to follow-up.

Gastrointestinal Infantile Hemangioma: Presentation and Management.

OBJECTIVES: The aim of the present study was to document the clinical presentation, diagnostic studies, and therapy of gastrointestinal infantile hemangiomas. METHODS: This is a retrospective analysis of children with gastrointestinal hemangiomas culled from our Vascular Anomalies Center database. We detailed the location of visceral and cutaneous tumors, as well as radiologic and procedural methods used for diagnosis and treatment. RESULTS: A total of 9 of the 16 children (14 girls and 2 boys) with hollow visceral hemangiomas also had cutaneous lesions. The most common extravisceral sites were regional facial lesions (n = 6), multifocal lesions (n = 2), and a solitary chest lesion (n = 1). Presenting symptoms were melena and hematochezia in the first 4 months of life (n = 14); several infants required multiple blood transfusions. The most frequent locations were small bowel and mesentery. One-half of the patients (n = 8) were diagnosed by laparotomy; the majority (n = 12) had suspicious radiologic findings. Corticosteroid and/or propranolol were the most common therapies. CONCLUSIONS: Melena and hematochezia, sometimes with profound anemia, in the first 4 months of life, suggest the possibility of intestinal infantile hemangioma even in the absence of cutaneous tumor. Intestinal bleeding, particularly in association with a regional facial lesion, should initiate workup: ultrasonography, computed tomography, and magnetic resonance imaging display diagnostic features. First-line treatment is medical management; bowel resection may be necessary, particularly for perforation.

Swept-source optical coherence tomography of retinal cavernous hemangioma: a new imaging modality.

The authors report a new, non-invasive diagnostic method in the diagnosis of retinal cavernous hemangioma (RCH). A 6-year-old girl was referred for a non-clearing retinal hemorrhage of 6 months' duration. Fourier-domain optical coherence tomography (FD-OCT) showed an intraretinal lesion with cystic-like internal appearance. Optical shadowing was present, preventing establishment of any subretinal component to the lesion. Swept-source OCT (SS-OCT) showed an intraretinal lesion consisting of a group of clearly defined grape-like caverns with overlying preretinal tissue. Wide-field fundus fluorescein angiography (WF-FFA) confirmed the diagnosis of RCH. SS-OCT was superior to FD-OCT in showing the internal anatomy of the RCH and allowing for the measurement of its structures, confirming the intraretinal location of the lesion and the presence of an associated preretinal tissue. SS-OCT may assist in cases in which hemorrhage prevents an accurate diagnosis by ophthalmoscopy or angiography, thus becoming an alternative imaging method to confirm the diagnosis of RCH while avoiding the risks of fluorescein angiography in children.

Potential correlation between menopausal status and the clinical course of orbital cavernous hemangiomas.

PURPOSE: To evaluate the clinical course of radiologically diagnosed orbital cavernous hemangiomas in the setting of presumed changes in estrogen/progesterone levels. METHODS: An institutional review board-approved retrospective cohort chart review of patients from January 1, 1983, to January 1, 2013, was undertaken searching both outpatient ophthalmology diagnoses and radiologic diagnoses, identifying 32 orbital cavernous hemangiomas, which were subsequently divided into group 1, presumed to have stable levels of estrogen/progesterone, and group 2, presumed to have decreasing levels of estrogen/progesterone. Patients were then categorized as having short-term, mid-range, or long-term follow up. Serial imaging studies were evaluated and graded as having increased, decreased, or remained stable in size. RESULTS: In group 1, no lesions decreased in size, 69% remained stable, and 31% increased in size. In group 2, no lesions increased in size, 45% remained stable, and 55% decreased in size. When evaluating only those patients with long-term follow up, many masses in group 1 increased in size, while the majority in group 2 decreased in size. CONCLUSIONS: In this study evaluating orbital cavernous hemangiomas over a span of 30 years, the authors found that in postmenopausal women with assumed decreasing levels of circulating estrogen/progesterone, the vast majority of lesions either remained stable or decreased in size, suggesting the effect of hormone levels on such vascular lesions and supporting the role for observation in asymptomatic individuals in this patient population.

Is surgical treatment of liver hemangiomas effective for pain relief?

BACKGROUND: Traditional treatment for liver hemangiomas is surgery. Currently, it is controversial whether hemangioma surgeries are sufficiently beneficial for the patients. In this study, we evaluated the effectiveness of surgery in patients with liver hemangiomas. METHODS: Forty-two patients who underwent surgical operations for hepatic hemangiomas were retrospectively evaluated and interviewed. RESULTS: Study population included 36 female and 6 male patients whose ages ranged between 26 and 65 years (mean age, 47.8 +-8.7 years). Their mean duration of hospitalization was 6 days (range, 3 - 59 days). The median time since surgery was 50 months (range 0-120 months). There was a statistically significant decrease in numerical rating and adjective rating pain scale scores (p 0.05). Postoperatively, pain did not cease in 10 patients (peptic ulcers requiring medical treatment in four patients, cholelithiasis in four patients, and nephrolithiasis in two patients). CONCLUSION: Patients with cavernous hemangiomas of the liver who require surgical treatment have significant benefits in terms of pain relief following surgery. The lack of pain relief after the surgery in some patients may be related to concomitant medical problems other than the hemangioma.

Recurrent varicose veins of the legs: a single centre experience.

AIM: The aim of our study is to report our experience on the surgery for recurrent varicose veins of the legs over the period 2007-2012. MATERIALS AND METHODS: A series of 480 consecutive surgical procedures for varicose veins of the legs was reviewed; among a total of 480 cases, 65 procedures were for recurrent varicose veins. Data collected included clinical characteristics, surgical techniques, cause of recurrence and surgical outcomes. We analyzed the causes of recurrences in order to determine factors that influence recurrence itself. RESULTS: Sixty-five procedures for recurrent varicose veins were analized. The main causes of recurrence were: persistence of collaterals at the saphenofemoral junction (27.7%), inadequate stripping of the long saphenous vein (18.5%), perforating veins insufficiency (66.1%), sapheno-femoral junction neovascolarisation (12.3%), inguinal or popliteal cavernoma (27.7%), recurrence after short saphenous venous surgery (4.5%). CONCLUSIONS: We concluded that, as is clear from our study, the main cause of recurrence is inadequate surgery. This can only be due to inadequate preoperative assessment (lack of rigorous clinical and US Doppler rigorous evaluation) and not correct surgical technique, as it may occur if the surgery is performed by a surgeon inexperienced in this type of surgery.

[Giant cavernous hemangioma of the orbit (case report)].

The following case demonstrates a successful en bloc removal of a massive cavernous hemangioma of the orbit via vertical transpalpebral approach with postoperative improvement of optic nerve condition and optimal cosmetic result.

Cavernous hemangioma of small bowel: a rare cause of digestive hemorrhage / Hemangioma cavernoso del intestino delgado: una causa rara de hemorragia digestiva

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Deep calf cavernous haemangioma in a 10 year- old girl: a case report.

Haemangiomas are abnormal proliferation of blood vessels in any vascularised tissue. They can be capillary or cavernous varieties. Cavernous are either of cutaneous or deep types. Cavernous when compared with the capillary haemangioma is rare. Rarer still is the deep type of cavernous haemangioma. This is a report of a 10 year old Nigerian girl who presented with a right posterior leg swelling of 8 year duration, size initially was that of a peanut but increased to fill the entire calf region causing pain to the patient as well as cosmetic and anxiety concern to the parents. No preceding history of trauma, no associated systematic symptoms. She had exploratory laparatomy at 1 year of age at a private hospital for an abdominal mass which was excised. Pre-operative plain radiograph, Magnetic Resonance Imaging(MRI), Abdominopelvic ultrasound scan (USS) were done, fine needle aspiration cytology (FNAC) though done was not helpful. Histo-pathology result of excised leg mass confirmed diagnosis; there was a free margin of excision. Post-operatively, clinical improvement was marked.

Hemangioma cavernoso sublingual / Sublingual cavernous haemanginoma

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