Angioleiomyoma of the Cavernous Sinus: Case Report

Abstract

OBJECTIVE AND IMPORTANCE: Angioleiomyomas (ALMs) are relatively rare, benign, vascular soft tissue tumors that occur most frequently in the extremities of middle-aged individuals. To date, only two cases of intracranial ALMs have been described, both with little emphasis on the clinical, surgical, and radiological aspects. Neither of these reported cases of ALM involved the cavernous sinus. Furthermore, there is no previous intracranial ALM magnetic resonance imaging scan described in the literature. This report presents the first case of cavernous sinus ALM, emphasizing the clinical, radiological, and surgical aspects. CLINICAL PRESENTATION: A 52-year-old man had a 2-year history of horizontal diplopia and frontal headache. Facial numbness and impaired visual acuity in the previous 6 months were also reported. Physical examination revealed paralysis of right Cranial Nerves III, IV, and VI. A decrease in optical acuity was also noted. Computed tomographic and magnetic resonance imaging scans demonstrated a mass lesion located in the right cavernous sinus, which enhanced homogeneously with administration of intravenous contrast medium. INTERVENTION: A total resection was performed via a right frontotemporal craniotomy and a pretemporal approach with peeling of the middle fossa. The postoperative course was uneventful. Histological examination identified the ALM, with no recurrence noted during follow-up. CONCLUSION: It is unknown why intracranial ALMs have not been reported more frequently in the literature. Although ALMs are a rare occurrence, misinterpretation of this lesion may also have contributed to the lack of reported cases. Before surgery, ALMs can be distinguished from meningiomas and schwannomas but not from hemangiomas. The prognosis of intracranial ALM is good, as suggested in this case as well as the two previously reported cases.

Infratentorial angioleiomyoma: a new location for a rare neoplastic entity

“…In 1994 Lach et al 10 described the first primary intracra nial angioleiomyoma, in an extraaxial location (leptom eningeal). To the present time, 4 additional intracranial cases have been documented; 4,7,8,14 of these, only the case reported by Ravikumar et al 14 was intraaxial (basal gan glia). Karagama et al 7 and Kohan et al 8 have verified le sions in the IAM.…”

“…Karagama et al 7 and Kohan et al 8 have verified le sions in the IAM. Figueiredo et al 4 have described a lesion in the cavernous sinus. Thus, our case is the first reported instance of an angioleiomyoma in an infratentorial loca tion that extends into and compresses the brain (cerebel lum).…”

“…5,10 An intracranial site for these tumors is exceed ingly rare, with only 4 reports documenting intracranial lesions with locations in the neuraxis, specifically within the region of the cavernous sinus, parietal lobe, internal auditory canal, and caudate nucleus. 4,10,14 We describe the first case, to our knowledge, of a CNS angioleiomyoma with an infratentorial location.…”

Parafalx angioleiomyoma: a case report and review of the literature

“…Intracranial ALMs are exceedingly rare. To date, only three cases of intracranial ALMs have been reported 2 – 4. None of these reported cases of ALM involved parafalx region.…”

Surgical Clipping of a Basilar Tip Aneurysm: Case Report and Literature Review

“…Approaches to basilar bifurcation aneurysms in most series are the subtemporal, pterional, "half-and-half" and frontotemporal routes [10]- [15]. It is widely reported that each of these approaches have advantages and disadvantages and; they are nonetheless associated with some degree of morbidity and mortality [3] [16] [17] [18] [19]. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach.…”