Primary Intraosseous Hemangioma of the Sphenoid

Introduction: Hemangiomas are benign vascular neoplastic disorders that may occur in any part of the body. Intraosseous hemangiomas are a rare entity; the most commonly involved site is the spine. In the skull they represent 0.2% of all bone tumors and 10% of the benign neoplasms.

Case: A 45-year-old female patient presented with a change of the pattern worsening of a chronic headache. A diagnostic investigation was performed and in the CT scan and MRI, a lesion in her sphenoid bone in the area of the sella was identified. It was opted for resection of the lesion through endoscopic transnasal approach. During surgery, it was identified an osseous lesion without invasion of other structures including dura mater, carotid artery, cavernous sinus or optic nerve. The entire lesion was removed, there was no cerebrospinal fluid leak, but critical structures was exposed; so, it was opted for reconstruction of the skull base with a nasoseptal flap. The postoperative period was uneventful and the patient fully recovered. The anatomopathological result was an intraosseous hemangioma and the patient returned to the old migrainous pattern of her headache, with control of the pain.

Discussion: Primary intraosseous hemangioma of the skull base are incredibly rare, in the skull the most common areas are the frontal and parietal bones. They are slow-growing lesions, occur more commonly in the 4th-5th decades of life and have a predilection for females. The main symptoms are deformity and headaches, which intensity may vary from dull to severe. However, the tumor may grow and compress other structures such brain parenchyma or cranial nerves. The radiographic characteristics are in CT expansive, well-circumscribed area with honeycomb pattern and in the MRI the signal characteristics are variable. The recommended treatment is surgical excision to treat mass effect and neurological compromise and to achieve a definitive diagnosis.

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