- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Japan
Correspondence Address:
Mitsutoshi Nakada
Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Japan
DOI:10.4103/2152-7806.92934
Copyright: © 2012 Furuta T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Furuta T, Nakada M, Watanabe T, Hayashi Y, Hamada J. Progressive tentorial cavernous malformation. Surg Neurol Int 15-Feb-2012;3:18
How to cite this URL: Furuta T, Nakada M, Watanabe T, Hayashi Y, Hamada J. Progressive tentorial cavernous malformation. Surg Neurol Int 15-Feb-2012;3:18. Available from: http://sni.wpengine.com/surgicalint_articles/progressive-tentorial-cavernous-malformation/
Abstract
Background:Because extra-axial cavernous malformations (CMs) are rare, the common clinical course remains unclear. We report the case of a patient with progressive CM originating from the cerebellar tentorium.
Case Description:A 64-year-old woman was admitted to our hospital with the complaint of diplopia. Magnetic resonance (MR) imaging revealed a lesion attached to the left cerebellar tentorium, close to the cerebral peduncle. This well-demarcated lesion rapidly enlarged for 3 months and eroded into the midbrain. Cerebral angiography showed a branch of the middle meningeal artery supplying the lesion and pooling of the contrast medium in the venous phase. A dark reddish and mulberry-like mass of the tentorium was observed intraoperatively, allowing the diagnosis of a tentorial CM. The feeding artery was identified in the tentorium and was coagulated. Postoperative MR imaging showed remarkable mass reduction and central necrosis of the lesion. However, the lesion recurred in 3 months; consequently, gamma knife radiosurgery was performed. After an additional 2 months, the lesion shrank in response to the radiosurgery.
Conclusions:We report an extremely rare case of tentorial CM which showed rapid growth in a short period. Coagulation of the feeding artery was not sufficient to control the lesion. Gamma knife radiosurgery may prove highly effective for recurrent lesions.
Keywords: Cavernous malformation, cerebellar tentorium, gamma knife
INTRODUCTION
Cavernous malformations (CMs), also known as cavernous angiomas or cavernomas, account for 3–13% of all intracranial cerebral vascular malformations[
CASE REPORT
A 64-year-old woman visited our hospital with the complaint of diplopia. Despite her subjective complaint, an objective neurological examination revealed no obvious cranial nerve disorder. Magnetic resonance (MR) imaging revealed a mass lesion located beside the left cerebral peduncle; this mass appeared isointense on T1-weighted imaging (T1WI) and hyperintense on fluid-attenuated inversion recovery (FLAIR) imaging [
The patient was placed in the supine position and a left orbitozygomatic craniotomy was performed. The lesion appeared as a multilobulated, mulberry-like mass located on the tentorium [
MR imaging 1 week after the operation showed central necrosis of the lesion concomitant with mass reduction and diminution of the perifocal edema in the midbrain [Figure
DISCUSSION
Intracranial extra-axial CMs located in the middle cranial fossa account for 3% of all benign cavernous sinus masses and usually attach to the cavernous sinus. Our case, however, was independent of the cavernous sinus.[
Most parenchymal CMs are stable in size for long periods, but occasionally grow by recurrent hemorrhages.[
On MR imaging, the lesion in our case appeared isointense to gray matter on T1WI and intensive enhancement, which are consistent with the typical findings in CM. At the border of the lesion, extra-axial CM sometimes exhibits a dural tail sign, as observed in our case,[
Surgical resection is a common treatment for extra-axial CM, although a lesion with a dural origin close to the cavernous sinus tends to bleed massively during removal.[
In contrast to intraparenchymal CM, both stereotactic radiosurgery and radiotherapy have been reported as effective tools for the adjunct treatment of extra-axial CM, particularly located at the cavernous sinus.[
CONCLUSIONS
We treated a rare case of progressive tentorial CM. Extra-axial CMs often mimic meningiomas. Their clinical behavior and appearance on imaging are quite different from those of intra-axial CMs. Fractionated or stereotactic radiotherapy is an effective treatment tool for the residual or recurrent extra-axial CM. Further research and longer follow-up periods are required for a better understanding of the natural history of CMs of the cerebellar tentorium.
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