The vascular mimic: successful surgical management of cavernous sinus hemangioma via adapted approach: Case report.

BACKGROUND: Cavernous sinus hemangioma (CSH) is a rare, benign vascular tumor presenting significant diagnostic and management challenges due to its location and mimicry of other sellar and parasellar masses. This report details such a case, emphasizing the diagnostic complexities and surgical adaptability required. PATIENT CONCERNS: A 47-year-old female presented with 3 months history of progressive left eye visual decline, intermittent headaches, and neck pain radiating to the left upper limb. DIAGNOSES: Imaging revealed a large sellar and parasellar mass with mass effect upon adjacent structures. INTERVENTIONS: Surgical management was initially via an endoscopic transnasal transsphenoidal approach; however, intraoperative findings of high vascularity and cerebrospinal fluid leakage necessitated conversion to a left pterional craniotomy with subtotal resection of this mass. Histopathology confirmed the diagnosis. OUTCOMES: Postoperatively, the patient had a good general outcome and remains under regular scheduled follow-up. LESSONS: Despite being rare, CSH should be considered among the causes of sellar and parasellar masses. Its location can lead to misdiagnosis, but imaging studies and a multidisciplinary team approach can decrease the risk of complications in such cases. While CSH are considered benign vascular tumors, they are associated with the risk of significant blood loss with surgery. This case highlights the importance of preoperative planning, intraoperative adaptability, and a multidisciplinary approach in managing large vascular brain tumors. Early diagnosis and appropriate surgical intervention can significantly improve clinical outcomes in complex cases.