Cavernomas of the skull: review of the literature 1975–2000

We describe four patients with intraosseous cavernous hemangiomas of the skull which were localized supraorbitally, parietally (two cases), and occipitally. The diameter ranged from 15 mm to 25 mm. They presented with slowly growing mass, tender to pressure, with spontaneous pain, and with freely mobile skin above the cavernoma sites. Magnetic resonance imaging (hyperintensity on T2 and isointensity with brain on T1) and CT (osteolytic lesion with erosion of the tabula externa) confirmed the plain skull films showing the honeycomb or sunburst appearance pattern. Resections and postoperative course were uneventful. In three of these cases there was coexistence with tumors (meningeoma, malignant lymphoma, and malignant melanoma); none of these constellations has been described before. Generally, cavernous hemangiomas of the skull are rare. There is one extensive review published by Barnes in 1984 regarding a period of 136 years with 123 intraosseous hemangiomas of the skull and 74 of the jaws. Unfortunately, the histological confirmation is not completely clear and some capillary hemangiomas are included. In a review of the literature since 1975, we found 103 histologically proven intraosseous cavernous hemangiomas of the skull (with our four cases included) and 22 of the jaws, which are shown in an overview with respect to their localization. The most frequent site was frontal, followed by temporal.