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AJNR - American Journal of Neuroradiology

Published ahead of print on February 12, 2009
doi: 10.3174/ajnr.A1478

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American Journal of Neuroradiology 30:1005-1013, May 2009
© 2009 American Society of Neuroradiology

PEDIATRICS

Infantile Hemangiomas Involving the Neuraxis: Clinical and Imaging Findings

V. Viswanathan^a, E.R. Smith^b, J.B. Mulliken^c, S.J. Fishman^c, H.P.W. Kozakewich^c, P.E. Burrows^e and D.B. Orbach^a,c,d

^a Neuroradiology Division, Brigham and Women's Hospital, Boston, Mass
^b Neurosurgery Division, Children's Hospital Boston, Boston, Mass
^c Vascular Anomalies Center, Children's Hospital Boston, Boston, Mass
^d Neurointerventional Radiology, Children's Hospital Boston, Boston, Mass
^e Vascular Malformations Center, Roosevelt Hospital, New York, NY

Please address correspondence to Darren Orbach, MD, PhD, Neurointerventional Radiology, Brigham and Women's Hospital, 75 Francis St, PBB-356, Boston, MA 02115; e-mail: dorbach{at}partners.org

BACKGROUND AND PURPOSE: The neuroradiology and neurosurgery literature is replete with references to "hemangioma" involving the central nervous system (CNS). However, the number of cases of true infantile hemangiomas in the CNS reported to date is 15. Our purpose was to delineate the definition of infantile hemangiomas, determine their prevalence in the neuraxis, and describe their imaging characteristics and associations in this location.

MATERIALS AND METHODS: We reviewed our Vascular Anomalies Center data base from 1999 through May 2008 to assess the prevalence of intracranial or intraspinal involvement within the total cohort of infantile hemangiomas. Fifteen patients were identified with infantile hemangiomas that involved the neuraxis. Two board-certified neuroradiologists reviewed the available imaging of these 15 patients, and a board-certified pathologist reviewed the available histopathology. Clinical records of all 15 patients were reviewed to identify the type of treatment and the treatment response.

RESULTS: Of the 1454 patients listed with infantile hemangioma, 15 (1.0%) had involvement of the CNS. Eight patients had intracranial infantile hemangioma, 6 had intraspinal hemangioma, and 1 had both. In most instances, there was continuous extension into the neuraxis from an extracranial or extraspinal lesion. There were no cases of a CNS hemangioma without an accompanying extra-CNS tumor. Two patients had findings consistent with posterior fossa anomalies, cervicofacial hemangioma, arterial anomalies, cardiac defects, ocular abnormalities, and associated sternal or ventral defect. Of note, there were no brain or spinal parenchymal signal-intensity abnormalities, and there was no evidence of parenchymal invasion.

CONCLUSIONS: CNS involvement by infantile hemangiomas is an unusual occurrence, which, when recognized, can help optimize patient management.