The Art of Mimicry: Anterior Clinoid Dural-Based Cavernous Hemangioma Mistaken for a Meningioma.

The Art of Mimicry: Anterior Clinoid Dural-Based Cavernous Hemangioma Mistaken for a Meningioma.

World Neurosurg. 2017 Feb 15;:

Authors: Mansour TR, Medhkour Y, Entezami P, Mrak R, Schroeder J, Medhkour A

Abstract
BACKGROUND: Cavernous hemangiomas account for 5-13% of central nervous system vascular lesions. They are usually found intra-axially but rarely involve extra-axial structures, most commonly the middle cranial fossa. A cavernous hemangioma presenting as a clinoid meningioma is extremely rare.
CASE DESCRIPTION: We present a 36-year-old male with an asymptomatic intracranial mass found incidentally after an ATV accident. Preoperative MRI revealed a well-defined dural-based lesion arising from the right anterior clinoid process which was nearly homogenously enhancing, with a radiological diagnosis of meningioma. The mass was resected via right pterional craniotomy with microsurgical technique. Complete resection of the mass was performed with no complications and, notably, no significant bleeding. Contrasting with the radiologic and gross tumor appearance, histopathologic examination revealed dilated vascular spaces, sclerotic vessels without intervening neural tissue, and intravascular thrombi suggesting slow blood flow - all consistent with cavernous hemangioma.
CONCLUSIONS: Anterior clinoid dural-based cavernous hemangioma are extremely rare. Though preoperative diagnosis is difficult using imaging, this etiology should be considered for any dural-based middle fossa lesion due to the tendency for these lesions to bleed heavily during resection in some instances.

PMID: 28214640 [PubMed - as supplied by publisher]

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