Synchronous orbital and intracranial infantile hemangiomas: a case report and literature review

Background: Solitary orbital and parasellar infantile hemangiomas (IHs) without cutaneous manifestations are exceptionally rare, posing significant diagnostic and therapeutic challenges due to the absence of management consensus. Case presentation: A 55-day-old female infant presented with progressive left-sided proptosis over the course of one month. Preoperative magnetic resonance imaging (MRI) revealed homogeneously enhancing masses in the left orbit (encasing the optic nerve) and the parasellar region, in which imaging characteristics resembled those of a meningioma. No cutaneous lesions or features of PHACE syndrome were identified. Following multidisciplinary team consultation, a single-stage left pterional approach for the simultaneous resection of both the orbital and parasellar lesions, with the aim of establishing a definitive histopathological diagnosis and relieving mass effect. Histopathological examination confirmed the diagnosis of cellular IH, which could be supported by characteristic morphology and positive immunohistochemical staining for GLUT-1 and CD31. Postoperative recovery was uneventful, with complete resolution of proptosis and no neurological deficits. Imaging confirmed total resection of both lesions. Conclusions: This case emphasizes that isolated intracranial/orbital IH should be included in the differential diagnosis of pediatric masses, even in the absence of skin involvement. When facing diagnostic uncertainty and significant symptomatology, surgical resection can be a safe and effective primary strategy, providing definitive diagnosis and immediate decompression.