Strawberries on the brain--intracranial capillary hemangioma: two case reports and systematic literature review in children and adults

Abstract

Background: Capillary hemangioma in the cranial cavity is rare. This report describes 2 additional cases presenting shortly after pregnancy and provides a systematic review summarizing clinical experience to date.

Methods: Case reports were compiled retrospectively. Patient 1 was a 28-year-old woman who presented with a simple partial seizure associated with left-sided visual distortions that progressed to a secondary generalized tonic-clonic seizure. Imaging revealed a contrast-enhancing lesion in the right temporal region adjacent to the transverse sinus, with vasogenic edema and scalloping of the inner table. The angiographic appearance suggested the correct diagnosis. Patient 2 was a 41-year-old woman who presented with progressive visual disturbance 6 months after giving birth to her second child. Subtle symptoms of headache and visual disturbance had commenced during pregnancy. Noncontrasted imaging displayed a homogenous tumor with surrounding vasogenic edema in the occipital region. PubMed and Science Citation Index were reviewed systematically for prior publications.

Results: Complete surgical excision was performed in both patients. Neuropathological examination confirmed benign capillary hemangioma consisting of a meshwork of capillary-sized and larger feeder vessels in both instances. Systematic review was based on 20 publications and a total of 24 patients; their clinical, radiological, and surgical features as well as management are summarized.

Conclusions: At follow-up, symptoms had resolved and magnetic resonance imaging confirmed complete removal in both patients. Intracranial capillary hemangioma is rare, and treatment is empirical. Review of limited published reports suggests that surgery is the most commonly used treatment and that complete excision seems most likely to prevent further recurrence.

Keywords: Capillary hemangioma; Clinical management; ICH; Interventional-radiology; Intracranial capillary hemangioma; Neuro-oncology; Systematic literature review.