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

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.

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