Objective      Intracranial extracerebral cavernous hemangiomas (ECAH) may develop in the .cavernous sinus. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We discussed our experience in treating intracranial extracerebral cavernous hemangiomas by gamma knife radiosurgery (GKS) and share experience for gamma knife usage.       Methods      A total of 6 symptomatic patients with ECAH who undergoing GKS between May 2002 to May 2009 were collected in this study. The hemangiomas were located in the cavernous sinus. The average volume of ECAH was 4.3 cm

3

(range from 3.8 to 6.8 cm

3

). The presenting symptoms included headache

orbital pain

diplopia

ptosis

proptosis and impaired visual acuity (6 patients). There were 4 patients treated by GKS based on c

linical and imaging criteria

and the left 2 patients receiving microsurgical partial excision biopsy first and then cured by GKS. The average of irradiation dose delivered to the margin was 12.9 Gy (ranging from 11 to 16 Gy). The dose to the optic nerve in all patients was less than 9 Gy (range 2.4 to 9 Gy). All patients were followed up for 6 months to 9 years.       Results      Five patients had symptom improvement

and one patient had persistent diplopia. Follow-up MRI image displayed that tumor disappeared in 1 patient

decreased in size in 4 patients

and had no change in 1 patient.       Conclusion      GKS is an effective and safe method to treat ECAH for the patients whose tumor are difficult to use surgical treatment or difficult to tolerance for surgery.