A giant solid cavernous hemangioma mimicking sphenoid wing meningioma in an adolescent

Abstract

Rationale:Central nervous system (CNS) solid cavernous hemangiomas are rare extra-axial anomalies that may sometimes resemble meningiomas. Due to their complex vascular nature, accurate preoperative diagnosis is important to avoid disastrous hemorrhage during operation. To the best of our knowledge this is the first case in an adolescent since all middle cranial fossa hemangioma cases reported in literature are adults in their 40s or 50s and all the pediatric cases are cystic.Patient concerns:We present a case of a 14-year-old girl with headache and dizziness for 3 months. She occasionally experienced nausea and vomiting but denied visual disturbances and loss of smell.Diagnoses:MRI revealed a lesion that extends to the greater wing of the sphenoid bone as well as the pituitary fossa. Our initial diagnosis was a sphenoid wing meningioma but interestingly, histopathology revealed solid cavernous hemangioma.Interventions:The residual tumor was completely removed with 2 sessions of Gamma Knife radiotherapy after surgery.Outcomes:We were confronted with excessive bleeding during surgery so we attained subtotal resection. However, the patient recovered well with no recurrence of the tumor.Lessons:Our case shows that space occupying lesions involving the cavernous sinus and sphenoid ridged could be easily misdiagnosed as sphenoid wing meningiomas in children and adolescents and even adults therefore great care must be exercised when confronted with this kind of presentation.

Giant Cavernous Malformation with Unusually Aggressive Clinical Course: a Case Report

“…While the common size cavernomas do not present a diagnostic dilemma 2,6,18 , GCs can have very heterogeneous CT presentation 19 . Therefore, distinguishing GC is quite challenging 9 . CT appearance of GC in our case was a hemorrhagic hyperdense lesion with mass effect and perifocal edema, which is usual but not specific for GC, and much more frequently seen in tumors 3,6,9,19 .…”

“…Therefore, distinguishing GC is quite challenging 9 . CT appearance of GC in our case was a hemorrhagic hyperdense lesion with mass effect and perifocal edema, which is usual but not specific for GC, and much more frequently seen in tumors 3,6,9,19 . Misdiagnosing a GC as oligodendroglioma due to post-hemorrhagic calcifications, as anaplastic or pilocytic astrocytoma due to the isodense appearance with poor contrast enhancement, as ependymoma or even metastatic melanoma with intratumoral hemorrhage has been reported 3,5 .…”

“…In case of bleeding GCs, imaging shows a nonspecific finding of the hypervascularized lesion. Digital subtraction angiography was not planned, and it is also considered redundant in these cases 9,20 .…”

“…Cavernomas (cavernous angiomas, hemangiomas) are benign, clearly defined, angiographically occult vascular malformations of the central nervous system, which are composed of vascular channels lined by one-layer endothelium separated by matrix made of collagenous tissue and smooth muscles [1][2][3] . Their prevalence ranges from 0.5% to 1% in the general population, and they account for 5%-15% of all intracranial vascular malformations [3][4][5][6][7][8][9][10] . They can be from a few millimeters to a few centimeters in size, usually smaller than 3 cm.…”

“…The mechanism of GC growth remains uncertain, although a combination of rebleeding and consequential reorganization processes is considered ( 2 ). GCs are usually intra-axial lesions, although some cases were related to the meninges ( 2 , 3 , 7 - 9 ). Familial form of GCs has not been reported ( 6 ).…”