title: Successful removal of a huge hypervascular tentorial cavernous angioma after preoperative endovascular embolization.
abstract: The authors report a rare case of a huge hypervascular tentorial cavernous angioma treated with preoperative endovascular embolization, followed by successful gross-total removal. A 15-year-old girl presented with scintillation, diplopia, and papilledema. Computed tomography and MRI studies revealed a huge irregularly shaped tumor located in the right occipital and suboccipital regions. The tumor, which had both intra- and extradural components, showed marked enhancement and invasion of the overlying occipital bone. Angiography revealed marked tumor stain, with blood supply mainly from a large branch of the left posterior meningeal artery. Therefore, this lesion was diagnosed as a tentorium-based extraaxial tumor. For differential diagnosis, meningioma, hemangiopericytoma, and malignant skull tumor were considered. Tumor feeders were endovascularly embolized with particles of polyvinyl alcohol. On the following day, the tumor was safely gross totally removed with minimum blood loss. Histopathological examination confirmed the diagnosis of cavernous angioma. To date, there have been no reports of tentorium-based cavernous angiomas endovascularly embolized preoperatively. A tentorial cavernous angioma is most likely to show massive intraoperative bleeding. Therefore, preoperative embolization appears to be quite useful for safe maximum resection. Hence, the authors assert that the differential diagnosis of tentorium-based tumors should include tentorial cavernous angioma, for which preoperative endovascular embolization should be considered.
authors.affiliation: Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshimura
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tsukamoto
authors.forename: Masakazu
authors.initials: M
authors.lastname: Sano
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nishino
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saito
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukuda
authors.forename: Kouichirou
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006393:Hemangiopericytoma / Q000175:diagnosis; D006801:Humans; D008577:Meningeal Neoplasms / Q000175:diagnosis; D008579:Meningioma / Q000175:diagnosis; D057234:Preoperative Period; D012888:Skull Neoplasms / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: CA = cavernous angioma; PVA = polyvinyl alcohol; cavernous angioma; embolization; hypervascular; profuse bleeding; tentorial tumor; vascular disorders