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Dural Cavernous Angioma: A Preoperative Diagnostic Challenge

Published online by Cambridge University Press:  02 December 2014

Dominic Rosso ,
Donald H. Lee ,
Gary G. Ferguson ,
Chetna Tailor ,
Sam Iskander  and
Robert R. Hammond
Dominic Rosso
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON Canada Diagnostic Radiology, London Health Sciences Centre, University of Western Ontario, London, ON Canada
Donald H. Lee
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON Canada Diagnostic Radiology, London Health Sciences Centre, University of Western Ontario, London, ON Canada
Gary G. Ferguson
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON Canada
Chetna Tailor
Affiliation:
Pathology, London Health Sciences Centre, University of Western Ontario, London, ON Canada
Sam Iskander
Affiliation:
Pathology, London Health Sciences Centre, University of Western Ontario, London, ON Canada
Robert R. Hammond
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON Canada Pathology, London Health Sciences Centre, University of Western Ontario, London, ON Canada
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Abstract

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Background:

Dural cavernous angiomas are uncommon benign vascular malformations which may present intraoperative difficulties in hemostasis when the diagnosis is not suspected preoperatively. Preoperative diagnosis can be difficult when angiomas show atypical features and share imaging characteristics with other entities.

Methods:

A patient presented with a radiographically aggressive lesion, subsequently identified as a dural cavernous angioma. The lesion is reviewed and its clinical, radiographic, and pathological features are compared with other vascular malformations.

Case report:

A 40-year-old man presented with new onset seizures and an enhancing lesion infiltrating the floor of the right middle cranial fossa. Due to its aggressive radiographic appearance, initial considerations included chondrosarcoma, meningioma or metastasis. Pathological examination, however, revealed the lesion to be a cavernous angioma of dura.

Conclusion:

This uncommon lesion may present a diagnostic challenge with significant intraoperative implications. T2 sequence hyperintensity in a relevant lesion should raise suspicion of an hemangioma. It is important to be aware of this entity and its potential to mimic other entities on radiographic grounds.

Résumé:

RÉSUMÉ:Introduction:

Les angiomes caverneux de la dure-mère sont des malformations vasculaires bénignes rares. L’hémostase peut faire problème au moment de la chirurgie si le diagnostic n’a pas été envisagé avant la chirurgie. Le diagnostic préopératoire peut être difficile à poser quand l’angiome présente des caractéristiques atypiques communes à d’autres pathologies.

Méthodes:

Il s’agit d’une lésion d’aspect agressif à la radiologie chez un patient chez qui on a éventuellement posé un diagnostic d’angiome caverneux de la dure-mère. Nous décrivons la lésion et nous comparons ses caractéristiques cliniques, radiologiques et anatomopathologiques à celles d’autres malformations vasculaires.

Étude de cas:

Un homme âgé de 40 ans a consulté pour des crises convulsives d’apparition récente. L’évaluation a montré la présence d’une lésion rehaussante infiltrant le plancher de la fosse cérébrale moyenne droite. Vu son aspect radiologique agressif, on a considéré la possibilité qu’il s’agisse d’un chondrosarcome, d’un méningiome ou de métastases. L’examen anatomopathologique a révélé qu’il s’agissait d’un angiome caverneux de la dure-mère.

Conclusions:

Cette pathologie rare peut présenter un défi diagnostique comportant des incidences opératoires importantes. Une hyperintensité sur la séquence pondérée en T2 au niveau de ce type de lésion devrait faire soupçonner la présence d’un hémangiome. Il est important de connaître les caractéristiques de cette pathologie et de garder à l’esprit que son aspect radiologique peut prêter à confusion.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 3 , August 2003 , pp. 272 - 277
Copyright
Copyright © The Canadian Journal of Neurological 2003

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