Skull vault hemangioma
Updates to Article Attributes
Skull vault haemangiomas (SVH), or haemangiomas of the calvaria, are benign slow growing vascular neoplasms affecting the skull diploe in any location.
Please refer to the article on intraosseous haemangiomas for a general discussion of that entity.
Epidemiology
Calvary isThe calvaria is the second most prevalent site for intraosseous haemangiomas, particularly the frontal and parietal bones 1, and represent 0.2% of all osseous tumours 2. Commonly occurs in women in the 4th-5th decade of life.
Clinical presentation
These tumours are slow growing and are generally asymptomatic, unless when palpable due to a lump produced by an expansion of the outer table 3.
Pathology
As an intraosseous haemangioma, SVH 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 1-3.
Radiographic features
Plain film
Lytic lesion with a sclerotic rim (usually with a honeycomb or sunburst-like appearance).
CT
Usually presented as an expansive bone lesion with thin borders and characteristic sunburst pattern of trabecular thickening radiating from a common centre. Erosions of both internal or external plates can occur and may be associated with internal or external tumour expansion.
Angiography (DSA)
DSA Is important for surgical planning of smaller lesions and embolizationembolisation of larger ones.
MRI
Signal intensity is somewhat variable, depending largely on the amount of fat content.
- T1: non-homogeneously hypo- to isointense signal
- T2/FLAIR: hyperintense signal
- T1 C+ (Gd): enhancement is often present
Treatment and prognosis
TreatmentTreatment is not always necessary and indications include: mass effects, haemorrhage control, and aesthetic improvement. Treatment options are:
radiation therapy
- embolisation to reduce intraoperative blood loss
- surgical resection
- intralesional ethanol injection
-<p><strong>Skull vault haemangiomas (SVH)</strong>, or <strong>haemangiomas of the calvaria</strong>, are benign slow growing vascular neoplasms affecting the skull diploe in any location. </p><p>Please refer to the article on <a href="/articles/primary-intraosseous-haemangioma">intraosseous haemangiomas</a> for a general discussion of that entity. </p><h4>Epidemiology</h4><p>Calvary is the second most prevalent site for intraosseous haemangiomas, particularly the frontal and parietal bones <sup>1</sup>, and represent 0.2% of all osseous tumours <sup>2</sup>. Commonly occurs in women in the 4th-5th decade of life.</p><h4>-<br>Clinical presentation</h4><p>These tumours are slow growing and are generally asymptomatic, unless when palpable due a lump produced by an expansion of the outer table <sup>3</sup>. </p><h4>Pathology</h4><p>As an intraosseous haemangioma, SVH 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 <sup>1-3</sup>.</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Lytic lesion with a sclerotic rim (usually with a honeycomb or sunburst-like appearance).</p><h5>CT</h5><p>Usually presented as an expansive bone lesion with thin borders and characteristic sunburst pattern of trabecular thickening radiating from a common centre. Erosions of both internal or external plates can occur and may be associated with internal or external tumour expansion. </p><h5>Angiography (DSA)</h5><p>DSA Is important for surgical planning of smaller lesions and embolization of larger ones. </p><h5>MRI</h5><p>Signal intensity is somewhat variable, depending largely on the amount of fat content. </p><ul>-<li>-<strong>T1:</strong> non-homogeneously hypo- to isointense signal</li>-<li>-<strong>T2/FLAIR:</strong> hyperintense signal </li>-<li>-<strong>T1 C+ (Gd):</strong> enhancement is often present</li>-</ul><h4>Treatment and prognosis </h4><p>Treatment is not always necessary and indications include: mass effects, haemorrhage control, and aesthetic improvement. Treatment options are:</p><ul>-<li><p>radiation therapy</p></li>-<li>embolisation to reduce intraoperative blood loss</li>-<li>surgical resection</li>-<li>intralesional ethanol injection</li>- +<p><strong>Skull vault haemangiomas (SVH)</strong>, or <strong>haemangiomas of the calvaria</strong>, are benign slow growing vascular neoplasms affecting the skull diploe in any location. </p><p>Please refer to the article on <a href="/articles/primary-intraosseous-haemangioma">intraosseous haemangiomas</a> for a general discussion of that entity. </p><h4>Epidemiology</h4><p>The calvaria is the second most prevalent site for intraosseous haemangiomas, particularly the frontal and parietal bones <sup>1</sup>, and represent 0.2% of all osseous tumours <sup>2</sup>. Commonly occurs in women in the 4th-5th decade of life.</p><h4>Clinical presentation</h4><p>These tumours are slow growing and are generally asymptomatic, unless when palpable due to a lump produced by an expansion of the outer table <sup>3</sup>. </p><h4>Pathology</h4><p>As an intraosseous haemangioma, SVH 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 <sup>1-3</sup>.</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Lytic lesion with a sclerotic rim (usually with a honeycomb or sunburst-like appearance).</p><h5>CT</h5><p>Usually presented as an expansive bone lesion with thin borders and characteristic sunburst pattern of trabecular thickening radiating from a common centre. Erosions of both internal or external plates can occur and may be associated with internal or external tumour expansion. </p><h5>Angiography (DSA)</h5><p>DSA Is important for surgical planning of smaller lesions and embolisation of larger ones. </p><h5>MRI</h5><p>Signal intensity is somewhat variable, depending largely on the amount of fat content. </p><ul>
- +<li>
- +<strong>T1:</strong> non-homogeneously hypo- to isointense signal</li>
- +<li>
- +<strong>T2/FLAIR:</strong> hyperintense signal </li>
- +<li>
- +<strong>T1 C+ (Gd):</strong> enhancement is often present</li>
- +</ul><h4>Treatment and prognosis </h4><p>Treatment is not always necessary and indications include: mass effects, haemorrhage control, and aesthetic improvement. Treatment options are:</p><ul>
- +<li>radiation therapy</li>
- +<li>embolisation to reduce intraoperative blood loss</li>
- +<li>surgical resection</li>
- +<li>intralesional ethanol injection</li>
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