Fractionated External-beam Radiation Therapy For Incompletely Resected Intracranial Extra-axial Cavernous Haemangioma: A Case Report

We report a case of a cavernous haemangioma arising from the left trigeminal nerve causing mass effect, midline shift and hydrocephalus. Surgical resection was attempted after immediate insertion of bilateral extra-ventricular drains, but complete resection was not achieved, with residual disease at the superior orbital fissure and cavernous sinus. Stereotactic radiosurgery was deemed unsuitable in view of proximity to the left optic nerve and optic chiasm, and the patient was hence treated with fractionated external-beam radiation therapy (RT) to a total dose of 40 Gy in 20 daily fractions over four weeks. The patient tolerated RT well, with no significant toxicity. MRI done eighteen months after completion of RT showed the continued decrease in the size of the lesion with reduced mass effect on the optic chiasm.