Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Intraosseous cavernous malformations of the skull: clinical characteristics and long-term surgical outcomes


Intraosseous cavernous malformations (ICMs) of the skull are relatively rare, benign, and slow-growing tumors. Knowledge of these lesions is poor. The goals of this study were to describe the clinical manifestations, radiological features, and long-term surgical outcomes of this disease. We performed a retrospective analysis of a series of 16 cranial ICM patients who underwent surgical treatment in our hospital between 2003 and 2016. The incidence of cranial ICM was 1.15% among the entire series of intracranial and intraspinal CMs. Our cohort included 6 male and 10 female patients; their mean age at operation was 38.7 years (range, 1.9 to 63 years). Slowly growing swelling was the commonest clinical manifestation of this disease. Complete lesion resection was achieved in all but one patient, and cranioplasty was performed using titanium mesh in 11 cases. Postoperative complication was found in one patient who developed diplopia, and this symptom resolved spontaneously before discharge. The mean follow-up period after operation was 76.2 months (range, 19 to 119 months). Only the patient with petroclival ICM had some occasional headaches (mRS = 1); others were all in stable neurological status (mRS = 0). No lesion recurrence was found during the follow-up period. Although cranial ICM is rare, it should always be considered as a differential diagnosis in the case of firm, gradually enlarging skull lesions. Surgical resection should be the treatment of choice for the symptomatic patients and their long-term outcomes were excellent after gross total removal.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Cervoni L, Artico M, Delfini R (1995) Intraosseous cavernous hemangioma of the skull. Neurosurg Rev 18(1):61–64

  2. 2.

    Heckl S, Aschoff A, Kunze S (2002) Cavernomas of the skull: review of the literature 1975–2000. Neurosurg Rev 25(1–2):56–62.

  3. 3.

    Toynbee J (1845) An account of two vascular tumors developed in the substance of bone. Lancet 2:676

  4. 4.

    Pilcher LS (1894) V. Venous tumor of the diploe. Ann Surg 20(2):165–167

  5. 5.

    Dogan S, Kocaeli H, Sahin S, Korfali E, Saraydaroglu O (2005) Large cavernous hemangioma of the frontal bone. Neurol Med Chir (Tokyo) 45(5):264–267

  6. 6.

    Vernet O, Bernasconi A, Fankhauser H (1993) Cavernous hemangioma of the frontal bone. Turk Neurosurg 3:118–121

  7. 7.

    Prasad GL, Pai K (2018) Pediatric cranial intraosseous hemangiomas: a review. Neurosurg Rev 41(1):109–117.

  8. 8.

    Yang Y, Guan J, Ma W, Li Y, Xing B, Ren Z, Su C, Wang R (2016) Primary intraosseous cavernous hemangioma in the skull. Medicine (Baltimore) 95(11):e3069.

  9. 9.

    Yu J, Li Y, Duan X (2014) Posttraumatic cavernous hemangioma of the skull. J Craniofac Surg 25(1):e48–e51.

  10. 10.

    Akhaddar A, Laaguili J (2014) Post-traumatic cavernous hemangioma of the frontal cranial vault. Pan Afr Med J 17:90.

  11. 11.

    Chatterji P, Sharma ML, Chatterji S, Kanwar DL (1969) Cavernous haemangioma of fronto-ethmoid region. J Laryngol Otol 83(9):925–933

  12. 12.

    Yoshida D, Sugisaki Y, Shimura T, Teramoto A (1999) Cavernous hemangioma of the skull in a neonate. Childs Nerv Syst 15:351–353

  13. 13.

    Vural M, Acikalin MF, Adapinar B, Atasoy MA (2009) Congenital cavernous hemangioma of the calvaria. Case report. J Neurosurg Pediatr 3(1):41–45.

  14. 14.

    Vargel I, Cil BE, Er N, Ruacan S, Akarsu AN, Erk Y (2002) Hereditary intraosseous vascular malformation of the craniofacial region: an apparently novel disorder. Am J Med Genet 109(1):22–35

  15. 15.

    Maraire JN, Awad IA (1995) Intracranial cavernous malformations: lesion behavior and management strategies. Neurosurgery 37(4):591–605

  16. 16.

    Fierek O, Laskawi R, Kunze E (2004) Large intraosseous hemangioma of the temporal bone in a child. Ann Otol Rhinol Laryngol 113(5):394–398.

  17. 17.

    Martínez-Lage JF, Torroba M, Cuartero Pérez B, Almagro M, López López-Guerrero A, de la Rosa P (2010) Cavernous hemangiomas of the cranial vault in infants: a case-based update. Childs Nerv Syst 26(7):861–865.

  18. 18.

    Sasagawa Y, Akai T, Yamamoto K, Masuoka T, Itou S, Oohashi M, Iizuka H (2009) Multiple cavernous hemangiomas of the skull associated with hepatic lesions. Case report. Neurol Med Chir (Tokyo) 49(4):162–166

  19. 19.

    Murrone D, De Paulis D, Millimaggi DF, Del MM, Galzio RJ (2014) Cavernous hemangioma of the frontal bone: a case report. J Med Case Rep 8:121.

  20. 20.

    Sharma RR, Pawar SJ, Lad SD, Netalkar AS, Musa MM (1999) Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia. Clin Neurol Neurosurg 101(3):215–219

  21. 21.

    Hsiao I, Cho D, Liu C (2015) Multifocal osteolytic lesions of the skull: a primary cavernous hemangioma mimicking a neoplastic invasive lesion. BioMed 5(2):12.

  22. 22.

    Peterson DL, Murk SE, Story JL (1992) Multifocal cavernous hemangioma of the skull: report of a case and review of the literature. Neurosurgery 30(5):778–782

  23. 23.

    Brandner JS, Rawal YB, Kim LJ, Dillon JK (2018) Intraosseous hemangioma of the frontal bone. Report of a case and review of the literature. J Oral Maxillofac Surg 76(4):799–805.

  24. 24.

    Nasi D, Somma LD, Iacoangeli M, Liverotti V, Zizzi A, Dobran M, Gladi M, Scerrati M (2016) Calvarial bone cavernous hemangioma with intradural invasion: an unusual aggressive course—case report and literature review. Int J Surg Case Rep 22:79–82.

  25. 25.

    Xu P, Lan S, Liang Y, Xiao Q (2013) Multiple cavernous hemangiomas of the skull with dural tail sign: a case report and literature review. BMC Neurol 13:155.

  26. 26.

    Khanam H, Lipper MH, Wolff CL, Lopes MB (2001) Calvarial hemangiomas: report of two cases and review of the literature. Surg Neurol 55(1):63–67

  27. 27.

    Ryu HS, Moon KS, Lee KH, Kim IY, Jung S (2017) Dural penetration of cavernous hemangioma on skull: an uncommon clinical presentation. World Neurosurg 110:39–42.

  28. 28.

    Politi M, Romeike BF, Papanagiotou P, Nabhan A, Struffert T, Feiden W, Reith W (2005) Intraosseous hemangioma of the skull with dural tail sign: radiologic features with pathologic correlation. AJNR Am J Neuroradiol 26(8):2049–2052

  29. 29.

    Matsumiya T, Nemoto H, Kasai Y, Maruyama N, Sumiya N (2015) Intraosseous venous malformation of the zygoma: a case report and literature review. Int J Surg Case Rep 12:132–136.

  30. 30.

    Hishiyama J, Isago T, Ito H (2015) Intraosseous hemangioma of the zygomatic bone. JPRAS Open 6:5–10.

  31. 31.

    Syal R, Tyagi I, Goyal A, Barai S, Parihar A (2007) Multiple intraosseous hemangiomas—investigation and role of N-butylcyanoacrylate in management. Head Neck 29(5):512–517.

  32. 32.

    Garcia-Marin V, Ravina J, Trujillo E, Gonzalez-Feria L (2001) Symptomatic cavernous hemangioma of the occipital condyle treated with methacrylate embolization. Surg Neurol 56(5):301–303

  33. 33.

    Naama O, Gazzaz M, Akhaddar A, Belhachmi A, Asri A, Elmostarchid B, Elbouzidi A, Kadiri B, Boucetta M (2008) Cavernous hemangioma of the skull: 3 case reports. Surg Neurol 70(6):654–659.

  34. 34.

    Liu JK, Burger PC, Harnsberger HR, Couldwell WT (2003) Primary intraosseous skull base cavernous hemangioma: case report. Skull Base 13(4):219–228.

  35. 35.

    Moore SL, Chun JK, Mitre SA, Som PM (2001) Intraosseous hemangioma of the zygoma: CT and MR findings. AJNR Am J Neuroradiol 22(7):1383–1385

  36. 36.

    Srinivasan VM, Karas PJ, Sen AN, Fridley JS, Gopinath SP (2016) Intracranial hypertension caused by occipital calvarial hemangioma: case report. World Neurosurg 91:671–672.

  37. 37.

    Salunke P, Sinha R, Khandelwal NK, Kumar A, Gupta K, Mukherjee KK (2010) Primary intraosseus cavernous hemangioma of the skull base. Br J Neurosurg 24(1):84–85.

  38. 38.

    Nasrallah IM, Hayek R, Duhaime AC, Stotland MA, Mamourian AC (2009) Cavernous hemangioma of the skull: surgical treatment without craniectomy. J Neurosurg Pediatr 4(6):575–579.

Download references


We would like to thank Dr. Meng Wang for her valuable advice in proofreading.


This study was funded by the National Natural Science Foundation of China (81371292) and the “13th Five-Year Plan” National Science and Technology supporting plan (2015BAI12B04).

Author information

Correspondence to Jizong Zhao.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All patients/legally authorized representative gave their informed consent (including consent to publish) before their inclusion to this study.

Ethical approval

This study was approved by the Research Ethics Board of Beijing Tiantan Hospital, Capital Medical University.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, C., Zhang, D., Wang, S. et al. Intraosseous cavernous malformations of the skull: clinical characteristics and long-term surgical outcomes. Neurosurg Rev 43, 231–239 (2020).

Download citation


  • Cavernous malformation
  • Cranial
  • Intraosseous
  • Skull neoplasm
  • Surgical treatment