Department of Magnetic Resonance Imaging Clinica Radiologica Vila Rica Brasilia DF Brazil Vila Rica Dr Sergio Lopes Viana SQS 105 Bloco D Apto 506 Asa Sul 70344040 Bras ID: 243191
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Arq Neuropsiquiatr 2004;62(4):1004-1007 Department of Magnetic Resonance Imaging, Clinica Radiologica Vila Rica, Brasilia DF - Brazil: Vila Rica; Dr. Sergio Lopes Viana - SQS 105 / Bloco D Apto 506 / Asa Sul - 70344-040 Braslia DF - Brasil. E-mail: radiolog@uol.com.brCAVERNOUS ANGIOMA OF THE CAVERNOUS SINUS , Sergio Lopes VianaMaria Angelica de Carvalho Barbosa Vianamasses, iso/hypointense in T1- and hyperintense in T2-weighted images. Differential diagnosis with para-sellar meningiomas and schwannomas can be difficult. We report three cases of this condition, describingfindings of diffusion-weighted imaging in this kind of lesion for the first time in literature.KEY WORDS: cavernous angioma, cavernous sinus, magnetic resonance imaging, computed tomography,angiography.Angioma cavernoso do seio cavernoso: achados aos exames de imagemPALAVRAS-CHAVE: angioma cavernoso, seio cavernoso, ressonncia magntica, tomografia computadori-extremely rare condition, and its differential diag-and schwannomas, is often difficult. They are rich-as we report in the study. of Clinica Radiologia Vila Rica, Brasilia DF, Brazil.are, respectively, presented with complaints of right-sided, presented with complaints of right-sidedve [patient 2] and VI nerve [patients 1 and 2]) and hea-daches. All of them underwent magnetic resonance ima-lar infusion of gadolinium. Diffusion-weighted sequence,RESULTS Arq Neuropsiquiatr 2004;62(4)1005 (Figs 6 and 7). Aneurysm was excluded in all pa-ed, hyperemic, reddish to brownish extra-dural pa- Fig 1. Patient 1. Well-circumscribed right para-sellar and supra-ous biopsy. Lesion encircles right internal carotid artery. the circle of Willis, which have preserved flow. Right internal ed image (1C) and isointense in diffusion-weighted sequence (1D).Note the right internal carotid artery encircled by accompanied of reduced ocular motricity, ptosis,mainly due to compressive effect or enclosure of 1006Arq Neuropsiquiatr 2004;62(4) Macroscopically, they appear as winy, well-cir-theses in differential diagnosis are, unlike observedwhen punctured. Microscopically, they are a honey-layer, without intervening neuronal tissue. Cal-cification is an occasional finding, and it is most com- ly maintaining its normal caliber. Figs 4 and 5. Patients 2 and 3. CT scans show right para-sellarand supra-sellar lesions, spontaneously hyperdense (4A and 5A),intensely enhancing after infusion of iodinated contrast media(4B and 5B). normally sized vessels, with adequate contrast flow. No masseffect could be seen (6A and 6B). Fig 7. Patient 2. Selective right carotid angiography. Arterialphase (7A), anteroposterior view, showing only slight stretch-segment. Venous phase (7B), lateral view, revealing a para-sel- Arq Neuropsiquiatr 2004;62(4)1007 tense in diffusion-weighted images in our onlypatient in which it was performed, and, to our kno-neous. The most important differential diagnosissis) is para-sellar meningioma. Although differentia-ningiomas usually are isointense with gray matternnomas tend to have lower signal than gray mat- of different surgical approaches possibly utilized.ly enhancing, avascular/hypovascular masses of thegeons for this possibility.1.Sohn CH, Kim SP, Kim IM, Lee JH, Lee HK. Characteristic MR imag-ing findings of cavernous hemangiomas in the cavernous sinus. AJNR2003;24:1148-1151.2.Bristot R, Santoro A, Fantozzi L, Delfini R. Cavernoma of the cav-ernous sinus: case report. Surg Neurol 1997;48:160-163.3.Momoshima S, Shiga H, Yuasa Y, Higuchi H, Kawase T, Toya S. MR find-ings in extracerebral cavernous angiomas of the middle cranial fossa:report of two cases and review of the literature. AJNR 1991;12:756-760.4.Suzuki Y, Shibuya M, Baskaya MK, et al. Extracerebral cavernousangiomas of the cavernous sinus in the middle fossa. Surg Neurol5.Gliemroth J, Missler U, Sephernia A. Cavernous angioma as a rare neuro-6.Tannouri F, Divano L, Caucheteur V, et al. Cavernous haemangiomain the cavernous sinus: case report and review of the literature.Neuroradiology 2001;43:317-320.7.Meneses MS, Dallolmo VC, Kondageski C, Ramina R, Hunhevicz S,Pedrozo AA. Cirurgia estereotxica guiada para angiomas cavernosos.Arq Neuropsiquiatr 2000;58:71-75.8.Andrade GC, Prandini MN, Braga FM. Cavernoma gigante: relato dedois casos. Arq Neuropsiquiatr 2002;60:481-486.9.Shi J, Hang C, Pan Y, Liu C, Zhang Z. Cavernous hemangiomas in thecavernous sinus. Neurosurgery 1999;45:1308-1312.10.Goel A, Muzumdar DP, Nitta J. Surgery on lesions involving cavernoussinus. J Clin Neurosci 2001;8(Suppl 1):S71-S77.