Albany Medical College, Albany, New York, USA.
Department of Pathology, Albany Medical Center, Albany, New York, USA.
World Neurosurg. 2020 Sep;141:3-7. doi: 10.1016/j.wneu.2020.05.188. Epub 2020 May 29.
Extraaxial cavernous hemangiomas (EACHs) are an extremely rare form of cerebral vascular malformations, occurring infrequently in children and rarely exceeding 6.0 cm in diameter (labeled as "giant"). Our case study highlights the radiographic, diagnostic, and interventional uncertainties in the management of giant EACHs in a pediatric population.
Our patient, a 15-year-old male with 3-month history of hemiparetic symptoms, was shown to have a 9.0-cm extraaxial parietal-occipital mass upon imaging. Differential diagnosis included cavernoma versus meningioma because of similarities in imaging presentation. Pathologic confirmation of EACH was achieved after resection, and the patient experienced positive outcomes including total recovery from his hemiparesis.
EACHs are difficult to characterize radiographically and are often mistaken to be meningiomas before resection and pathologic confirmation. Therefore cavernous hemangiomas should be considered in the differential diagnosis of pediatric extraaxial masses. Additionally, preoperative hemorrhage control efforts should be pursued to reduce adverse outcomes stemming from resection of vascular malformations such as EACHs.
颅外海绵状血管瘤（EACH）是一种极其罕见的脑血管畸形，在儿童中很少见，直径超过 6.0 厘米（称为“巨大”）的情况更为罕见。我们的病例研究强调了在儿童人群中管理巨大 EACH 时存在的影像学、诊断和介入方面的不确定性。
我们的患者是一名 15 岁男性，有 3 个月的偏瘫症状史，影像学检查显示其颅外顶枕部有一个 9.0 厘米的肿块。鉴别诊断包括海绵状血管瘤和脑膜瘤，因为它们在影像学表现上相似。切除后通过病理证实为 EACH，患者的预后良好，偏瘫完全恢复。
EACH 在影像学上难以特征化，在切除和病理证实之前，常被误诊为脑膜瘤。因此，在儿童颅外肿块的鉴别诊断中应考虑海绵状血管瘤。此外，应在术前进行出血控制，以减少 EACH 等血管畸形切除引起的不良后果。
