Mansour Tarek R, Medhkour Yacine, Entezami Pouya, Mrak Robert, Schroeder Jason, Medhkour Azedine
Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
World Neurosurg. 2017 Apr;100:708.e19-708.e22. doi: 10.1016/j.wneu.2017.02.029. Epub 2017 Feb 15.
Cavernous hemangiomas account for 5%-13% of central nervous system vascular lesions. They are usually found intra-axially but rarely involve extra-axial structures, most commonly the middle cranial fossa. A cavernous hemangioma manifesting as a clinoid meningioma is extremely rare.
A 36-year-old man presented with an asymptomatic intracranial mass found incidentally after a motor vehicle accident. Preoperative magnetic resonance imaging revealed a well-defined dural-based lesion arising from the right anterior clinoid process that was nearly homogeneously enhancing. The radiologic diagnosis was meningioma. The mass was resected via a right pterional craniotomy with microsurgical technique. Complete resection of the mass was performed with no complications and no significant bleeding. Contrasting with the radiologic and gross tumor appearance, histopathologic examination revealed dilated vascular spaces, sclerotic vessels without intervening neural tissue, and intravascular thrombi suggesting slow blood flow-all consistent with cavernous hemangioma.
Anterior clinoid dural-based cavernous hemangiomas are extremely rare. Although preoperative diagnosis is difficult using imaging, this etiology should be considered for any dural-based middle fossa lesion, owing to the tendency for these lesions to bleed heavily during resection in some instances.
海绵状血管瘤占中枢神经系统血管病变的5% - 13%。它们通常位于轴内，但很少累及轴外结构，最常见于中颅窝。表现为床突脑膜瘤的海绵状血管瘤极为罕见。
一名36岁男性在机动车事故后偶然发现无症状颅内肿块。术前磁共振成像显示一个边界清晰、起源于右侧前床突的硬膜下病变，几乎呈均匀强化。放射学诊断为脑膜瘤。通过右侧翼点开颅术采用显微外科技术切除肿块。肿块完全切除，无并发症且无明显出血。与放射学和大体肿瘤表现不同，组织病理学检查显示血管腔扩张、硬化血管且无中间神经组织，以及血管内血栓提示血流缓慢——所有这些均符合海绵状血管瘤。
起源于前床突硬膜的海绵状血管瘤极为罕见。尽管术前通过影像学诊断困难，但对于任何起源于硬膜的中颅窝病变都应考虑这种病因，因为这些病变在某些情况下切除时容易大量出血。
