Management of Intracranial Hemangioma in a Neonate?

Kikuo Ohno, MD

Disclosures

March 31, 2000

Question

We have a case of intracranial tumor diagnosed prenatally (31 weeks gestation). The baby girl was born at the 37th week, and biopsy revealed a hemangioma. Can you offer any suggested readings or references that may help?

José Matos Cruz

Response from Kikuo Ohno, MD

Neonatal intracranial tumors of vascular origin are very rare. Although the region and size of the tumor were not described in this baby, the tumor must have been big enough to be detectable during the prenatal period. Neonatal hemangiomas present as cavernous hemangiomas, hemangioendotheliomas, or as intracranial involvement of diffuse neonatal hemangiomatosis or Kasabach-Merritt syndrome.

If the neonate presents with hydrocephalus caused by the tumor, it is necessary to perform a cerebrospinal fluid diversion procedure. If the tumor is accompanied by complications such as thrombocytopenia attributable to consumption coagulopathy, or high output cardiac failure, and the surgical approach to the tumor is not difficult, it should be removed as early as possible.

One case has been reported[1] in which recombinant alpha-interferon treatment was effective in reversing thrombocytopenia and leading to regression of an intracranial hemangioma in an infant with Kasabach-Merritt syndrome. Such medical treatment or radiotherapy may help to control the tumor in a case with surgically inaccessible tumor and thrombocytopenia. Intracranial extracerebral and intracerebral cavernous hemangiomas in the newborn are uncommon, but they may develop intracranial bleeding or mass effect.[2] Radical surgical removal seems to be the treatment of choice in surgically accessible cases.

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