Extra-Axial Cavernous Angioma: A Case Report and Review of the Literature

Abstract

Cavernous angiomas (CAs) are benign vascular malformations predominantly seen in the brain parenchyma and therefore referred to as intra-axial. Extra-axial dural-based cavernous angiomas, on the other hand, are rare vascular lesions found outside of the brain parenchyma. They occur in the middle fossa and may be easily misdiagnosed as meningiomas due to their extra-axial location. In addition, CAs that are located outside the middle fossa, such as in the convexity, have a better prognosis since they are more surgically accessible. Surgical resection is the main treatment of choice in CAs. However, other options, such as embolization and radiotherapy, may also be considered therapeutic choices or additive treatment options. The pathogenesis of CA and the involvement of other factors (genetics or environmental factors) are still unknown and require further investigation. We are presenting a young man who presented for evaluation of seizure-like events without any family history of neurologic conditions. The physical examination was unremarkable except for a slightly antalgic gait. Imaging studies showed an extra-axial left tentorial mass suggestive of a meningioma, hemangiopericytoma, or other extra-axial lesions. The lesion was resected where its vascular nature was mentioned initially, and the histology proved the diagnosis of cavernous angioma. Here we give an overview of the known pathogenesis, causes, clinical features, and diagnostic and therapeutic options in CA. Better knowledge about CA, its causes, clinical features, and treatment options would help clinicians in early diagnosis and patient management.

Rare case of tentorial cavernous malformation mimicking a meningioma: illustrative case

“…In a recent review by Hassanzadeh et al, 91 extra-axial cavernous malformations were identified in the literature dating from 1947 to the present. 3 Of these, 11 were located on the tentorium. This figure corresponds to 12% of the reported cases ( Table 1 ).…”

“…Focal neurological deficits and seizures have been reported in the literature. 3 The exact rate of hemorrhage is unknown, with the reported 9% risk for hemorrhage possibly overestimated, as the natural history is based largely on intra-axial cavernous malformations. 15 …”

“…Extra-axial cavernous malformations are thus rare. 3 Tentorial cavernous malformations have only been reported in 10 cases in the available literature. 3 – 12 In 98% of cases, cavernous malformations occur in the brain parenchyma or spinal cord, often associated with a developmental venous anomaly.…”

“… 3 Tentorial cavernous malformations have only been reported in 10 cases in the available literature. 3 – 12 In 98% of cases, cavernous malformations occur in the brain parenchyma or spinal cord, often associated with a developmental venous anomaly. On computed tomography (CT) or magnetic resonance imaging (MRI) without and with contrast, differentiating these lesions from meningiomas is challenging.…”