OBJECTIVETo summarize the magnetic resonance imaging(MRI)features and microsurgical treatment of cavernous sinus hemangiomas(CSH).

METHODSTwenty-three patients with surgically and pathologically verified CSH were reviewed. All patients underwent computed tomography(CT)and MR scan, 19 cases underwent MR diffusion-weighted imaging(DWI)and 7 underwent single voxel (1)H magnetic resonance spectroscopy((1)HMRS)before operation. The microsurgery through modified pterional approach was performed in 11 cases and 12 cases removal was achieved in combined fronto-temporal preauricular subtemporal approach. Nineteen cases with large tumors were treated by Leksell Gamma knife(LGK)before operation.

RESULTSCSHs were single, large, and spherical/lie gourd-shaped tumors across the inside and outside the sella. CSH showed equal or slightly low signal on T1WI, high signal on T2WI and FLAIR, homogeneous or heterogeneous great enhancement on MR enhancement scan 19 cases showed equal or slightly low signal on DWI, 7 cases showed no NAA, Cr, and Cho peak, and 6 cases showed Lip peak on (1)HMRS. In 23 cases, the tumors were totally removed in 18, subtotally removed in 3, and partially removed in 2. No perioperative death was reported. The postoperative symptoms were improved in 17 cases but remained unchanged in 4 cases two patients suffered from new nervous symptoms after the surgery, which were improved or cured after three weeks of treatment. In 5 patients who had received subtotal or partial removal of the lesions, LGK was performed postoperatively, which resulted in smaller residual tumors in 4 cases and unchanged tumor in one patient. CONCLUSIONS CSH has some unique MRI features, and therefore MRI is helpful to improve the preoperative localization and qualitative diagnosis. The microsurgery through modified pterional approach combined with fronto-temporal preauricular subtemporal approach is an effective procedure for CSH.