skull vault hemangioma

Imaging of
skull vault tumors in adults. Bone hemangiomas. Case 1 (a–c): CT (a), T1WI (b), and T2WI (c) show well-defined lytic lesion, with thickened cortical and medullar trabecular spaces (arrows in a), and internal T1 and T2 hyperintense signal corresponding to fat and vascular tissue (arrows in b and c). Case 2 (d, e): CT (d) and T1WI (e) show marked bone expansion, fat content (dashed arrows), and strikingly enlarged trabecula producing a “spoke-wheel” appearance. Case 3 (f): CT depicts interruption of outer cortical table with overcoming enlarged spiculated trabecula simulating aggressive periosteal reaction (arrowhead)
insightsimaging.springeropen.com • CC-by-4.0
Cavernous
hemangioma of the frontal bone: a case report. A magnetic resonance imaging scan shows a hypointense lesion (yellow arrow) on the T1-weighted image (A) and a hyperintense lesion (pink arrow) on the T2-weighted image (B); a computed tomography scan reveals an osteolytic lesion (green arrow) with erosion of the tabula externa (C); a three-dimensional reconstruction of the skull with evidence of the lesion in the pre-operative time (red arrow) (D).
jmedicalcasereports.biomedcentral.com • CC-by-2.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. Computed tomography scan bone window coronal image showed 3 variables sized, rounded, diploic, expansile, lytic lesions with sunburst appearance (Red arrows), two biparietal, and left occipital (a). CT scan bone window axial image showed biparietal diploic lesions (b). The right one without wall erosion (Yellow arrow) while the left one with external wall erosion and subgaleal soft tissue (Green arrow)
bmcneurol.biomedcentral.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. Hypertrophied and tortuous left ECA occipital branch with persistent tumor blush (Red arrows), (a). Post embolization of the feeders from the left occipital artery and the left middle meningeal artery (Green arrow), (b)
bmcneurol.biomedcentral.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. Sagittal T1 MRI image showing empty Sella turcica (red arrow) (a) and distended optic nerve sheaths (Blue arrows) on coronal T2 (b)
bmcneurol.biomedcentral.com • CC-by-4.0
Intraosseous
cavernous hemangioma: presentation of a clinical case. Radiological images of a left frontal intraosseous lesion. a Simple X-ray of the skull, in the antero-posterior view and b in the lateral view of a radiolucent lesion (white arrows), rounded, with well-defined edges, located in the left frontal bone. c First CT cerebral with bone window performed on the patient 3 years ago. In localization of the left frontal region, a lytic bone lesion is observed that discreetly expands the diploe both in its internal and external table, with well-defined contours in its medullar region, being worse defined there could even be minimal solutions of continuity in the internal table. A poorly defined trabecular bone pattern was observed inside the lesion. The findings are compatible with a moderate aggressiveness. d In the last CT cerebral, it was appreciated how the lesion had increased in size. Produces a slight insufflation of the frontal calotte with loss of the cortex of the external table. Its behavior is of low radiological aggressiveness
EJNS.springeropen.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. CE-MRV MIP (a) sagittal and (b) axial showed absent enhancement of the superior sagittal dural sinus posteriorly (Red arrow), and the left transverse dural sinus (Yellow arrows). The left sigmoid dural sinus is small/ hypoplastic (Blue arrow). Panel c, is a CT scan bone window showing a shallow left sigmoid groove (Blue arrow) as compared to the right deep groove (White arrow)
bmcneurol.biomedcentral.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. CE-MRA MIP coronal (a), axial (b), and sagittal (c) showed two tortuous arteries (Red arrows) arising from the prominent left occipital artery (Yellow arrow) giving blood supply to the left occipital lesion
bmcneurol.biomedcentral.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. MRI images T1WI (a), T2WI (b), FLAIR (c), Hemo (d), and post contrast (e) the left occipital lesion showed hyperintensities on T1WI/T2WI of fat and vascular content respectively (Red arrow), and blooming effect (Blue arrows) on Hemo images of hemorrhagic content, and intense post-contrast enhancement (Yellow arrows). It compressed the adjacent occipital lobe without edema, deviating anteriorly the occipital horn (Blue asterisk) of the left lateral ventricle, and obstructing the posterior aspect of the superior sagittal sinus (Red asterisk)
bmcneurol.biomedcentral.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. Serial axial MRI (post contrast T1) done on February 2017 (a); January 2018 (b) and April 2019 (c), showing progressive enlargement of the soft tissue component and increased mass effect
bmcneurol.biomedcentral.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. Fluid attenuated inversion recovery (FLAIR) MRI (a), and post contrast T1 (b) show the left parietal diploic lesion with external wall erosion (Yellow arrow) and subgaleal soft tissue enhancement (Red arrow)
bmcneurol.biomedcentral.com • CC-by-4.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. Non-enhanced computed tomography (NECT) scan of brain (a); and bone window (b) showing large left occipital, expansile, lytic lesion with sunburst (Red arrows) appearance, and intracranial extension with soft tissue (Yellow arrows) component
bmcneurol.biomedcentral.com • CC-by-4.0
Radiological
review of skull lesions. Osseous venous vascular malformation. Axial head CT (a) shows osteolytic changes (trabecular appearance) of the clivus (dashed arrow) extending into the left occipital condyle (thin arrow). Sagittal T1-weighted (b), axial T2-weighted (c) and post-contrast sagittal T1-weighted images (d, e) show abnormal signal in the clivus (dashed arrows) and left occipital condyle (thin arrow) with enhancement
insightsimaging.springeropen.com • Open Access
Radiological
review of skull lesions. Osseous venous vascular malformation. Sagittal T1-weighted imaging (a), axial T2-weighted imaging (b) and sagittal contrast-enhanced venogram (c) show a hypointense T1, hyperintense T2 and enhancing lesion in the occipital bone (arrows)
insightsimaging.springeropen.com • Open Access
Als
Zufallsbefund entdeckte Läsion der Schädelkalotte bei einer Frau. Der Befund ist in allen Sequenzen isointens mit dem Unterhautfettgewebe. Es dürfte sich um ein intraossäres Lipom der Schädelkalotte handeln. Eine fettgesättigte Sequenz oder eine Computertomographie mit negativen Dichtewerten könnte im Zweifel den Verdacht noch weiter erhärten. DD fettreiches Hämangiom.
Wikipedia • CC BY-SA 3.0
A unique case
of multiple calvarial hemangiomas with one large symplastic hemangioma. Scout view of preoperative CT scan showing parietal (yellow arrow) and occipital bony lesions. The occipital lesion was larger with internal trabeculations (red arrows), and a major intracranial part with spiculated margins (blue arrows)
bmcneurol.biomedcentral.com • CC-by-4.0
Spectrum of
lytic lesions of the skull: a pictorial essay. Intraosseous haemangioma (IH). Coronal (a) and axial (b) reformats of a CT scan with bone window indicate a left frontal expansive lesion with thin margins and intralesional spicules, radiating from a common centre, which erodes the outer layer of the skull, with relative sparing of the inner table
insightsimaging.springeropen.com • CC-by-4.0
Bild wie bei
Hämangiom der Schädelkalotte in der Computertomografie und (rechts oben) Kernspintomografie (T1 nativ coronar). Der scharf begrenzte, lytische Defekt zeigt trabekuläre Strukturen im Inneren und ansonsten fettisodichte Dichtewerte und eine Hyperintensität in der T1-gewichteten Sequenz ebenfalls als Zeichen fettiger Anteile.
Wikipedia • CC BY-SA 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Skull vault hemangiomas (SVH), or hemangiomas of the calvaria, are benign slow-growing vascular lesions affecting the skull diploe in any location. They have been more recently renamed osseous venous (low-flow) vascular malformations given their nonneoplastic nature, but "hemangioma" remains commonly used.

Please refer to the article on intraosseous hemangiomas for a general discussion of that entity.

Epidemiology

The calvaria is the second most prevalent site for intraosseous hemangiomas, particularly the frontal and parietal bones . It represents 10% of benign neoplasms of the skull and 0.2% of all osseous tumors . Commonly occurs in women in the 4-5decades of life with a 3:1 female-male ratio .

Clinical presentation

These tumors are slow-growing and are generally asymptomatic, unless when palpable due to a lump produced by an expansion of the outer table .

Pathology

As an intraosseous hemangioma, skull vault hemangiomas are classified as venous, cavernous, or capillary type, according to their predominant vascular network. Histologically, it demonstrates hamartomatous vascular tissue within endothelium, but may also contain fat, smooth muscle, fibrous tissue, and thrombus .

Radiographic features

Plain radiograph

Lytic lesion with a sclerotic rim (usually with a honeycomb- or sunburst-like appearance).

CT

Usually presents as an expansile bone lesion with thin borders and a characteristic sunburst pattern of trabecular thickening radiating from a common center . Erosions of both internal or external plates can occur and may be associated with internal or external tumor expansion. Sometimes, bony trabeculae can grow beyond the cortical bone, and simulate an aggressive pseudo-"hair-on-end" periosteal reaction .

Angiography (DSA)

DSA is important for the surgical planning of smaller lesions and embolization of larger ones.

MRI

Signal intensity is somewhat variable, depending largely on the amount of fat content .

  • T1: typically hyperintense, though atypical T1 hypointense forms are not rare. 
  • T2/FLAIR: hyperintense signal with a "bunch of grapes" appearance
  • T1 C+ (Gd): homogeneous enhancement is often present

Treatment and prognosis 

​Treatment usually not necessary. Rare indications include: mass effect, hemorrhage control, and aesthetic improvement. Treatment options are:

  • radiation therapy
  • embolization to reduce intraoperative blood loss
  • surgical resection
  • intralesional ethanol injection
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Hämangiom Schädelkalotte:
Läsionen der
Schädelkalotte
Wikipedia • CC BY-SA 3.0
Osteolysen
der Kalotte
insightsimaging.springeropen.com • CC-by-4.0
Sinus
pericranii
www.eurorad.org • CC by-nc-sa-4.0
intraossäres
Hämangiom
Wikipedia • CC BY-SA 3.0
venöse
Kanäle und Lakunen der Kalotte
insightsimaging.springeropen.com • Open Access