Abuzayed Bashar, Said Anas, Jamous Osama, Al-Ashqar Omar, Al-Abadi Hussein, Alawneh Khalid
Department of Neurosurgery, Al-Bashir Governmental Hospital, Amman, Jordan.
Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Surg Neurol Int. 2020 Nov 11;11:386. doi: 10.25259/SNI_664_2020. eCollection 2020.
Extra-axial cavernomas at the cerebellopontine angle (CPA) are rare clinical entity that can radiologically mimic several lesions encountered at this location.
A 36-year-old female patient referred to our emergency service with acute decreased level of consciousness and vomiting. Neurological examination showed Glasgow Coma Scale of 12 with downbeat nystagmus of the right eye. Brain computed tomography scan and magnetic resonance imaging showed multilobulated extra-axial mass lesion located in the right CPA. The lesion was with various signal intensities in T1- and T2-weighted images suggestive of hemorrhages of different ages. T2 gradient echo sequences showed multiple sinusoid-like channels and diffuse hemosiderin deposition. These figures were compatible with cavernous malformation. The patient was operated by retrosigmoid approach. Dissection of the mass from the trigeminal, facial, vestibulocochlear, and lower cranial nerves was performed and total resection of the tumor was achieved. Histopathological examination confirmed the diagnosis of cavernoma.
Although CPA cavernomas are very rare, they should be considered for differential diagnosis when evaluating CPA lesions preoperatively for better intraoperative management and postoperative outcomes.
桥小脑角（CPA）区的轴外海绵状血管瘤是一种罕见的临床实体，在影像学上可模仿该部位遇到的几种病变。
一名36岁女性患者因急性意识水平下降和呕吐被转诊至我们的急诊服务部门。神经系统检查显示格拉斯哥昏迷量表评分为12分，右眼有下跳性眼球震颤。脑部计算机断层扫描和磁共振成像显示位于右侧CPA区的多叶状轴外肿块病变。该病变在T1加权和T2加权图像中具有多种信号强度，提示不同时期的出血。T2梯度回波序列显示多个类窦状通道和弥漫性含铁血黄素沉积。这些表现符合海绵状畸形。患者采用乙状窦后入路进行手术。从三叉神经、面神经、前庭蜗神经和低位颅神经分离肿块，实现了肿瘤的完全切除。组织病理学检查证实为海绵状血管瘤。
尽管CPA海绵状血管瘤非常罕见，但在术前评估CPA病变时应考虑进行鉴别诊断，以获得更好的术中管理和术后结果。
