Case Report
Dural cavernous haem angioma of the anterior cranial fossa

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Abstract

Extra-axial cavernous haem angiomas are uncommon lesions histologically identical to cavernomas in other locations. However, their radiological features and clinical behaviour may differ. They are frequently misdiagnosed preoperatively, as they often mimic other tumours. We describe a patient suffering from loss of the sense of smell, due to a cavernous haemangioma implanted in the dura mater of the anterior cranial fossa close to the olfactory bulb. To our knowledge, this is the first patient reported with such a lesion.

Introduction

Cavernous haem angiomas or cavernomas are benign lesions that account for 5% to 15% of all vascular malformations of the central nervous system (CNS). They can appear anywhere in the CNS. However, most are intraparenchymal lesions situated in the subcortical white matter, the brainstem or the basal ganglia, among other locations.[1], [2], [3] Extra-axial cavernomas are rare (0.4–2%),3 but most commonly occur in the middle cranial fossa, related to the cavernous sinus.[1], [3], [4] Other locations (tentorium, convexity, anterior cranial fossa, cerebellopontine angle, Meckel’s cave, sella turcica, internal auditory meatus or related to cranial nerves) are rarer, and only about 20 reports have been published.[3], [4], [5], [6], [7], [8], [9], [10], [11], [12] Differential diagnosis includes other extra-axial enhancing tumours, mainly meningiomas.

We present the first reported patient with a cavernous haem angioma implanted in the dura mater of the skull base in the anterior cranial fossa.

Section snippets

Case report

A 47-year-old Caucasian female with a history of hypothyroidism treated with replacement therapy attended our centre, reporting a loss of the sense of smell during the previous month. No other symptoms were present and physical examination was normal. MRI of the head showed a 14 mm by 10 mm extra-axial lesion in the anterior cranial fossa midline, in the region of the olfactory sulci but slightly lateralized to the right. The lesion was hypointense on T1-weighted MRI and hyperintense on

Discussion

The clinical behaviour and radiological features of extra-axial cavernous haem angiomas differ from intraparenchymal lesions, although they are identical histopathologically. They differ depending on their location: some authors have considered cavernous sinus haemangiomas to be vascular tumours rather than vascular malformations due to their high risk of bleeding and re-bleeding, and worse prognosis.13 Thus, the nature of these specific lesions is controversial.4

Extra-axial cavernomas are more

Conclusion

Although extra-axial cavernous haem angiomas are uncommon, they must be included in the differential diagnosis of dural lesions attached to the skull base of the anterior cranial fossa. Extra-axial and intra-axial cavernomas present different clinical, radiological and therapeutic features. Most cavernomas are related to the middle cranial fossa, only being rarely located elsewhere. The location of this cavernoma subtype outside the middle cranial fossa and not associated with the cavernous

Acknowledgments

The authors thank Cristina Ruiz Quevedo for assistance in the translation of the manuscript. None of the authors have received any financial support for this work.

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