Commentary

Hemangiomas involving the cavernous sinus are difficult to excise because these tumors bleed excessively. Their nature necessitates their removal in one piece; therefore, preservation of the cranial nerves becomes quite challenging. The authors' case presents a relatively avascular, solid tumor with histological features of a cavernous hemangioma with an abundance of hyalinized connective tissue. Because the lesion was avascular, it was possible to remove it completely in a piecemeal fashion, preserving all cranial nerve function. The surgical treatment was appropriate, and the outcome of this particular case was excellent.

However, a management dilemma will arise with a patient with a smaller tumor producing minimal deficit. In contrast to a meningioma, such a cavernous hemangioma would be an ideal lesion to excise and cure if the differentiation can be made preoperatively. At this time, most centers would probably be inclined to treat small lesions in this area with radiosurgery. Because no imaging characteristics distinguish such cavernous hemangiomas from meningiomas and schwannomas, the only way to diagnose a sclerosing cavernous hemangioma is by surgical exploration. The authors have made us aware of another entity in the spectrum of tumors of the cavernous sinus.