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|Year : 1993 | Volume
| Issue : 4 | Page : 222-3
Dural cavernous haemangioma of posterior cranial fossa.
A Goel, S Achwal, RD Nagpal
Dept of Neurosurgery, KEM Hospital, Parel, Bombay, Maharashtra.
Dept of Neurosurgery, KEM Hospital, Parel, Bombay, Maharashtra.
Source of Support: None, Conflict of Interest: None
A rare case of extracerebral dural cavernous angioma sited near the sigmoid sinus is reported. This 60 yr old male patient gave history of episodic ataxia of left sided limbs experienced twice on same day and occasional giddiness. Examination did not reveal any findings. A mass was diagnosed on CT Scan following which angiography was carried out. The features matched with those of a meningioma. Retro-sigmoid craniectomy was performed. Occipital artery was coagulated. Tumor was dissected out. Post-operative course of the patient was uneventful. Histopathology revealed that the mass was a cavernous haemangioma.
Keywords: Ataxia, etiology,Case Report, Cerebral Angiography, Cranial Fossa, Posterior, Craniotomy, methods,Diagnosis, Differential, Dizziness, etiology,Dura Mater, Hemangioma, Cavernous, complications,diagnosis,surgery,Human, Male, Meningeal Neoplasms, complications,diagnosis,surgery,Middle Age, Tomography, X-Ray Computed,
|How to cite this article:|
Goel A, Achwal S, Nagpal R D. Dural cavernous haemangioma of posterior cranial fossa. J Postgrad Med 1993;39:222
Intracranial extracerebral - 'dural' cavernous haemangiomas are extremely rare. Most of the extracerebral cavernous haemangiomas reported have been sited in the middle cranial fossa near the cavernous sinus. Cavernous haemangiomas arising from the dura of the posterior cranial fossa in proximity to the sigmoid sinus, have not yet been reported. The clinical and radiological picture of dural haemangiomas can resemble that of a meningioma, as was in the case presented.
A 60year-old male patient (NS no. 1114/92) twice experienced episodic ataxia of the left sided limbs. Each episode lasted for a few minutes, and occurred on the same day, 2 months prior to admission. Apart from occasional giddiness in the past, he had no other problem. Examination failed to reveal any abnormal findings. A computerized tomographic (CT) scan showed a hyperdense, enhancing mass in the lateral part of the left cerebellar hemisphere, adjacent to the posterior surface of the petrous bone, near the sigmoid sinus [Figure - 1]. Angiogram showed that the fairly vascular tumour was fed by a branch of the occipital artery. Pre-operative embolisation was considered to be unnecessary. With a pre-operative diagnosis of a meningioma a retro-sigmoid craniectomy was performed. The large occipital artery encountered during the exposure was coagulated. The reddish tumour was found to be attached to the posterior surface of the petrous bone close to the sigmoid sinus. The dural attachment, and blood supply from the attachment simulated the appearance of a meningioma. After the attachment of the tumour was disconnected, the tumor could be easily shelled out from the concavity of the cerebellar cortex. The arachnoid membrane over the cerebellar surface was intact. The patient fared well after the operation. Histopathology revealed a structure of a cavernous haemangioma. There were large vascular spaces lined by endothelial cells. The wall wag made up of dense collagenous tissue [Figure - 2].
Carvernous angiomas are usually located in the cerebral parenchyma, more often in the region of the parietal brain and in the basal ganglia, extracerebral, dural cavernous haemangiomas are rare. These have more often been located in the middle cranial fossa base around the cavernous sinus.  Other reported rare sites of these lesions include internal auditory canal, suprasellar region , tentorium cerebelli and convexity dura, Cavernous angiomas originating from the dura in the region of sigmoid sinus have not been reported earlier. Dural cavernous angiomas usually are well-circumscribed lesions and the clinical and CT scan features can resemble a meningioma,. Occasional cases presenting as epidural haemorrhage have been reported. Female predominance is known. The age incidence is usually between the 3rd and 6th decades. However, neonatal cavernous angiomas have been recorde. Enlargement of these lesions during pregnancy has been reported,.
Histologically, these lesions are composed of sinusoidal spaces lined by endothelium without any elastic or muscular layer. Hyaline degeneration, thrombosis, calcification and hemorrhage in the lesion may be seen.
Angiography may sometimes reveal an avascular mass. More often, dense hyper-vascularity, venous pooling, blush and neovascularization is seen-. CT scan picture resembles that of a meningioma ,. MRI scanning with Gadolinium contrast enhancement is considered to be the most specific investigation .
Surgery can be easy, as in our case. It is obvious, removal en masse, if possible will avoid the problems associated with piece meal removal. The latter can lead to uncontrollable haemorrhage. Such piecemeal removal or excision from sites such as cavernous sinus can lead to morbidity. Adjuvants such as endovascular therapy can help in making surgery safer. In cases where this is not feasible, and profuse intra-operative haemorrhage is feared pre-operative radiation therapy may be helpful.
To conclude we are reporting a dural haemangioma in relation to the sigmoid sinus. A similar case could not be located in the literature. The problems related to excision of such lesions have been discussed briefly.
The authors acknowledge with gratitude the help and guidance of Dr Sunii K Pandya.
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[Figure - 1], [Figure - 2]
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