Page 27 - Read Online

Oommen et al. Cavernous sinus cavernous hemangioma

Dural-based cavernomas are histologically similar to parasellar space occupying lesions especially if
intraparenchymal cavernous angiomas. However, neuroradiological data suggest a meningioma. Intra-
Rosso et al. showed a completely different cavernous hemangioma give high signal intensity on
[6]
appearance on computed tomography (CT), MRI and T2W images, with a strong homogenous enhancement
angiography. This fact makes accurate preoperative on contrast enhanced T1W images. It is important to
diagnosis very difficult, as imaging findings can be keep this entity among the differentials when planning
varied and resemble meningiomas. resection of a lesion that seems to be a meningioma.
Cavernous angiomas bleed profusely during surgery,
Cavernous dural hemangiomas can closely resemble hence perioperative mortality is high as a result of
meningiomas on CT and MRI in terms of signal uncontrollable bleeding. Preoperative angiogram and
characteristics, enhancement pattern, and localization. embolization are also recommended. The treatment of
choice should always include surgery since it allows
The CT appearance of dural cavernous hemangiomas, histopathological confirmation.
like meningiomas, shows a well-defined extra-axial
mass lesion on a broad dural base with regular Financial support and sponsorship
contrast. Occasional calcifications may be present. Nil.
[5]
[5]
The cerebral angiography may not be performed when
CT or MRI findings are felt to be diagnostic, and the Conflicts of interest
lesion is surgically accessible. [5] There are no conflicts of interest.
On MRI, cavernomas are usually either isointense or Patient consent
hypointense on T1 sequences and mixed to hyper- Informed consent was obtained from the patient.
intense on T2W sequences. Much like on CT, they also
usually enhance on MRI. Meningiomas can also appear Ethics approval
hyper-intense on T2 sequences, though they are The patient was treated within the standards of our
usually hypo-intense. Hence, a T2 hyperintense lesion institute and the report was approved.
is far from specific for dural-based cavernoma outside
the middle cranial fossa. Moreover, cavernomas can REFERENCES
have dural tails like meningiomas, and may also cause
significant perilesional edema. [7] 1. Kashlan ON, Sack JA, Ramnath S. Cavernous angioma of the dural
convexity mimicking a meningioma. Austin Neurosurg Open Access
Angiography can show a tumor blush, hypervascularity 2014;1:1019.
or an avascular mass. Even angiography can be 2. Riant F, Bergametti F, Fournier HD, Chapon F, Michalak-Provost S,
completely negative, or demonstrate pooling of Cecillon M, Lejeune P, Hosseini H, Choe C, Orth M, Bernreuther
contrast medium during the late venous phase. C, Boulday G, Denier C, Labauge P, Tournier-Lasserve E. CCM3
mutations are associated with early-onset cerebral hemorrhage and
In the present scenario, where medical and surgical 3. multiple meningiomas. Mol Syndromol 2013;4:165-72.
Lewis AI, Tew JM Jr, Payner TD, Yeh HS. Dural cavernous angiomas
sciences have advanced, stereotactic radiosurgery outside the middle cranial fossa: a report of two cases. Neurosurgery
represents a therapeutic option. This seems to be 1994;35:498-504.
crucial because dural cavernous hemangiomas are 4. Tsutsumi S, Yasumoto Y, Saeki H, Ito M. Cranial dural cavernous
different from meningiomas in their clinical features angioma. Clin Neuroradiol 2014;24:155-9.
such as surgical difficulty and sensitivity to radiosurgery. 5. Di Vitantonio H, De Paulis D, Ricci A, Marzi S, Dehcordi SR, Galzio
Although the treatment of choice is the total surgical RJ. Cavernous hemangioma of the dura mater mimicking meningioma.
removal, it is also possible to treat the lesion with Surg Neurol Int 2015;6:S375-8.
radiosurgery after the histopathological confirmation in 6. Rosso D, Lee DH, Ferguson GG, Tailor C, Iskander S, Hammond RR.
Dural cavernous angioma: a preoperative diagnostic challenge. Can J
cases of a partial removal. Neurol Sci 2003;30:272-7.
7. Joshi V, Muzumdar D, Dange N, Goel A. Supratentorial convexity
In conclusion, the occurrence of dural cavernomas dural-based cavernous hemangioma mimicking a meningioma in a
may be suspected in the presence of extra-axial child. Pediatr Neurosurg 2009;45:141-5.

Neuroimmunology and Neuroinflammation ¦ Volume 4 ¦ January 20, 2017 19