Neurographics

Primary Vascular Lesions of the Cavernous Sinus: Beyond “Hemangioma”

B.D. Weinberg, R.D. Goff, B.P. Soares, S.G. Neill, D. Wrubel, J. Velazquez, and C.A. Holder

View Article on Neurographics Website

Date of Activity Release: Oct. 1, 2018
Date of Activity Expiration: Oct. 1, 2021

Target Audience:
Intended for neuroradiologists and neuroradiology trainees with varying degrees of experience.

Learning Objective:
Describe the imaging appearance of cavernous hemangiomas, recognize other lesions in the differential diagnosis, and understand treatment options.

Abstract
Cavernous sinus hemangioma is a broad and somewhat misunderstood term that is frequently used to describe a range of primary cavernous sinus vascular lesions, including true vascular tumors in children, such as infantile hemangioma and congenital hemangioma, and adult vascular malformations. Because terminology related to these lesions has been confusing and controversial, more precise terminology is preferred, with use of the term “hemangioma” to refer to true vascular tumors, whereas adult vascular malformations, most commonly venous malformations, are described by their primary components. Although benign, cavernous sinus vascular lesions can be difficult to diagnose and treat, particularly given the anatomic complexity of the cavernous sinus region. MR imaging findings include well-circumscribed margins, marked T2 hyperintensity, and avid enhancement, though atypical lesions occur. The differential diagnosis includes meningioma, schwannoma, pituitary adenoma, chondrosarcoma, chordoma, metastasis, aneurysm, and inflammatory disease. Surgical resection was once the treatment of choice, though radiosurgery is becoming a more common primary treatment. This article reviewed the imaging, diagnostic, and treatment approaches to primary vascular lesions of the cavernous sinus, including both vascular tumors of childhood and adult vascular malformations.

Commercial Support
No commercial support was received for this activity.

Credit Designation Statement

The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Physician Participation:
Each participant will review the corresponding Neurographics article located at www.neurographics.org. Upon completion, each physician will complete and pass a post-test with a score of at least 80% to receive a CME certificate.

Disclosures:
All individuals in control of content have disclosed the following relevant financial relationships. All of these relationships were treated as a conflict of interest, and have been resolved (C7 SCS 6.1-6.2, 6.5)

Authors:
Authors have no relevant financial relationships.

Planners:

Name

Role

Relationship/Interest

Barton Branstetter 

Editor in Chief

None, N/A

Adam Flanders

Deputy Editor

Royalties, Lippincott Williams and Wilkins

Robert Quencer 

Consulting Editor

None, N/A

Mark Mullins

Associate Editor

Non-remunerative position, AUR6

Meng Law

Associate Editor

Stockholder, Clinical Imaging

Edward Escott

Associate Editor

Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers

Scott Faro

Associate Editor

None, N/A

Tina Young Poussaint

Associate Editor

None, N/A

Dheeraj Ghandi

Associate Editor

Grant, Arstasis, Axera Inc.; Consultant, Covidien, EV3

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