Specific Imaging Findings

Hemangioma (cavernous hemangioma, cavernous malformation) of the cavernous sinus shows characteristically marked T2 hyperintensity, approaching that of CSF. The tumors are typically homogenous and well-delineated, hypointense on T1-weighted images and with avid post-contrast enhancement. Enhancement may be homogenous or heterogenous, depending on the histologic type. Reflecting their large extracellular spaces, these benign neoplasms also show very high diffusion of water molecules, being almost as bright as CSF on ADC maps. Hemangiomas are hypodense on CT, remodeling of the adjacent bone may be present, without destruction or invasion. Similar to hemangiomas in other parts of the body, these vascular tumors demonstrate progressive filling in with contrast on dynamic and delayed MRI and CT images. Their very early enhancement following contrast bolus has a prominent tumor blush appearance, which may be appreciated on cranial CTA studies.

Pertinent Clinical Information

Cavernous sinus hemangioma may possibly be an incidental finding; however, they usually present with diplopia (extraocular muscle palsy, primarily oculomotor nerve), facial numbness, visual loss and headache. Optimal management is not clear at this time – total microsurgical removal is effective but may be extremely difficult and carries the risk of cranial nerve deficits; low-dose radiosurgery appears to lead to significant tumor shrinkage and clinical improvement. While radiosurgery may also be used following incomplete tumor excision, it is likely to become the treatment modality of choice.