Skull vault hemangiomas (hemangiomas of the calvaria) are rare, benign masses of the skullcap, accounting for about 7% of all osseous tumors of the neurocranium. There are two types: a cavernous (common) and a capillary (rare) form. Osseous hemangiomas can also occur in the vertebral bodies of the spine.

Epidemiology

They make up approximately 7% of all osseous masses of the skullcap. Most often, hemangiomas occur in the vertebral bodies.

Clinical presentation

Patients typically develop a solid, raised mass on the skullcap. These are often painless. Very rarely, redness of the skin over the lesion may be observed.

Radiological findings

On CT imaging, hemangiomas can show both lytic and sclerotic components. The pattern may appear trabecular or honeycomb-like, up to a spoke-wheel appearance. In predominantly sclerotic forms, the inner and outer cortex remains intact. On MRI with contrast, a locally limited enhancement is seen. Differential diagnosis should always consider osseous metastasis.

Differential diagnoses

• Epidermoid and Dermoid
• Osseous metastasis
• Osteoma
• Langerhans cell histiocytosis (syn. eosinophilic granuloma)
• Meningioma (intraosseous)
• Craniofacial fibrous dysplasia

Indication for surgery

Easily accessible hemangiomas can be surgically resected “en bloc” with a small safety margin. Alternatively, curettage may be performed. Plastic coverage with bone cement is usually necessary to guarantee the best cosmetic result when a craniotomy is performed. For lesions that are difficult to access, radiation therapy may be considered.

Outcome

Outcome:
The outcome for these benign masses is good. Recurrences are rare after surgical resection.

References

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