Cavernous Angioma Mimicking Meningioma

Abstract

The authors present a rare case of cavernous angioma mimicking a meningioma in a 58-year-old man who presented with a headache and dizziness. There were no neurological deficits or other neurological symptoms or signs. An extra-axial mass lesion thought to be associated with diffusely well-enhanced falx in the postcontrast sections was noted in the posterior interhemispheric fissure near the posterior part of the corpus callosum splenium. Extra-axial cavernous angiomas (cavernomas) are extremely rare lesions. They most commonly occur in the parenchyma but have been occasionally reported to arise from the dura matter. Dural cavernous angiomas arise from dural sinuses, falx cerebri, tentorium cerebelli, cranial base dura, or internal auditory canal dura and convexity. Parenchymal cavernous angiomas classically have a ring of hemosiderin surrounding the lesions observed on magnetic resonance imaging, but dural cavernous angiomas do not display the same magnetic resonance imaging characteristics and occasionally exhibit a dural tail sign due to which they can often be misdiagnosed as meningiomas.

A Rare Case of Frontal Lobe Cavernous Malformation Mimicking Meningioma

“…Furthermore, even though angiographic tests are frequently negative, a small vascular redness may occasionally be observed. Even the most expert radiologists find it difficult to discern between the two before surgery [1]. In the present case, even though scalloping of the frontal bone was present, lack of hyperostosis favored the diagnosis of cavernous malformation than meningioma.…”

“…For parenchymal cavernous angiomas, a reticulated core with a hemosiderin ring and mixedsignal intensity is considered a diagnostic finding [9]. For identifying microhemorrhages and hemosiderin rings, SWI is more sensitive than MRI [1].…”

“…Cavernous venous malformations, also known as cavernomas, are benign vascular lesions that commonly occur in the brain parenchyma [1]. These are well-circumscribed, larger, clustered sinusoidal vessels that are isolated from parenchymal tissue by a single layer of the epithelium [2].…”

“…The sinusoidal vascular channels are found within the brain and are separated by fibrous tissue; nevertheless, there is no intervening neural parenchymal or major feeding or draining arteries or veins [3]. They are most commonly seen in the parenchyma of the brain, although they can also be found in the spinal cord and extra-axial sites [1].…”

“…In the general population, 5-13% incidence of cavernoma is seen in all vascular malformations in central nervous systems. Among the locations in the brain, supra-tentorial is the most common location [1]. Extraaxial cavernomas account for about 14% of all cavernomas [4].…”