Gliomas are central nervous systems tumours which are diffusely infiltrative and difficult to treat. The extent of surgical resection is correlated with improved outcomes, including survival and disease-free progression. Cancerous tissue can be directly visualised intra-operatively under fluorescence by administration of 5-aminolevulinic acid to the patient. The adoption of this technique has allowed surgeons worldwide to achieve greater extents of resection, with implications for improved prognosis. However, there are practical limitations to use of 5-aminolevulinic acid. New adjuncts in the field of fluorescence-guided surgery aim to improve recognition of the interface between tumour and brain with the objective of improving resection and patient outcomes.

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BackgroundCapillary hemangiomas of the central nervous system are exceedingly rare. These are benign tumour-like lesions that usually occur in the skin and soft tissues of mainly children. We report the case of an extra-axial capillary hemangioma mimicking a tentorial meningioma.Case presentationA 46-year old female patient presented with headaches. Imaging revealed an avidly enhancing tentorial lesion with a wide dural base, features suggestive of a meningioma. Intra-operatively, an extra-axial heavily vascular tumour was found and was radically resected en bloc. Histology revealed thin-walled capillary-sized vessels arranged in closely packed lobules, and a diagnosis of capillary hemangioma was made. At one year follow up, the patient was asymptomatic and no tumour recurrence was noted.ConclusionsA literature review showed that capillary hemangiomas may be misdiagnosed as other extra-axial dural-based lesions such as meningiomas, schwannomas, hemangiopericytomas and inflammatory granulomatous lesions. Diagnosis should be considered especially in radiologically atypical cases. Complete excision is curative. Stereotactic radiosurgery on its own or in conjunction with surgery also achieves good results while partial excision or biopsy alone often leads to recurrence.

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The Chiari I malformation (CM-I) is characterised by overcrowding of the posterior fossa and descent of the cerebellar tonsils and is associated with syringomyelia. With the increasing availability of magnetic resonance imaging, CM-I is placing a growing burden on neurosurgical services. However, its natural history remains poorly understood, and the timing and nature of surgical intervention is controversial. We present a case of a significant, symptomatic CM-I with associated syrinx which underwent complete spontaneous resolution over a 4-year period. Spontaneous regression of Chiari malformation and syringomyelia is exceedingly rare; a literature review reveals 15 other cases and only one case which underwent complete resolution. The present case and literature review suggest a more benign natural history of CM-I and support a more conservative approach to its management. Further studies are required to determine whether any factors can predict resolution for certain patient cohorts.