Multiple cavernous hemangiomas of the skull with dural tail sign: a case report and literature review

Abstract

BackgroundPrimary intraosseous cavernous hemangioma is a rare bony tumor. To date, only 9 cases of multiple lesions and 2 cases with a dural tail sign have been reported.Case presentationHere, we present a case of multiple cavernous hemangiomas of the skull with dural tail sign in a 24-year-old man. No abnormalities were observed in the right orbit by craniography, but frontal bone destruction was unintentionally discovered. Computed tomography and magnetic resonance imaging demonstrated multiple intraosseous lesions that destroyed the surrounding bone and intracranial extension. Total resection of the two lesions and cranioplasty were performed. Histological examination confirmed the lesions as a cavernous hemangioma.ConclusionCavernous hemangioma is a rare bony tumor that should be considered in the differential diagnosis of skull tumors. Resection of all lesions should be performed on patients with multiple cavernous hemangiomas, and these patients should have regular follow-up examinations. Based on this case, and our literature review, we found that outcomes are usually very good.

Primary Cavernous Haemagioma of the Skull: Report of 2 Cases

“…17 Radiography of the skull is the most useful method to identify PICHs. 18 In 1930 Bucy and Capp definitely described the radiographic Characteristics as a expansive, well-circumscribed area of rarefaction with a sunburst pattern of trabeculations radiating from a common center. 19 When viewed enface or on axial views, honeycomb or soap-bubble configuration is characteristic.…”

“…23 Total surgical resection is the major treatment of skull PICH. 18 Because the imaging findings are not specific, pre-operative diagnosis is difficult, histopathology being essential.…”

Rare and challenging extra-axial brain lesions: CT and MRI findings with clinico-radiological differential diagnosis and pathological correlation

“…7a−7d). The hyperintensity of hemangiomas at T1-weighted sequences is an important distinguishing feature for this tumor (11).…”

Commentary

“…[3] The first hemangioma found in the skull was described by Toynbee in 1845, and this condition was defined by Rowbotham from the histological point of view until 1924. [34] The pathogenesis is unknown but is believed to be either congenital or related to previous trauma. [5] Hemangioma is classified on the basis of the dominant vessel in capillary, cavernous, or mixed type.…”

“…[7] The features found in X-rays and MRI are similar to those described in the literature (in the X-rays, the typical features are a “honey-comb” or “sunray” pattern, and in the MRI, high-signal intensity on T2-weighted and contrast enhancement). [4] However, it emphasizes the destruction of the inner table, its large size with mass effect and edema of the brain parenchyma,[6] with being rare. The definitive diagnosis only by radiological evaluation is not easy because many conditions involving bone tissue can appear as an osteolytic defect.…”