Sellar Cavernous Hemangioma with Internal Carotid Artery Encasement

Abstract

Sellar and parasellar cavernous hemangiomas are rare vascular malformations that often mimic more common lesions such as meningiomas or pituitary macroadenomas. We report a 60-year-old hypertensive male who presented with subacute left-sided weakness, dysphasia, and subtle cranial nerve deficits. MRI showed a large lobulated sellar and parasellar mass with T1 isointensity, marked T2 hyperintensity, centripetal post-contrast filling, and complete encasement of the cavernous segment of the left internal carotid artery, without luminal thrombosis. The lesion was initially treated with neuronavigation-guided pterional craniotomy and partial resection, and the diagnosis of cavernous hemangioma was made retrospectively after correlation with the dynamic enhancement pattern. We compare this case with published series regarding demographics, internal carotid artery encasement, imaging characteristics, and outcomes with surgery versus stereotactic radiosurgery. Accurate preoperative recognition of the characteristic imaging pattern is crucial because it may shift management towards primary radiosurgical treatment, which is associated with high rates of tumor control and lower cranial nerve morbidity.