title: The Art of Mimicry: Anterior Clinoid Dural-Based Cavernous Hemangioma Mistaken for a Meningioma.
abstract: BACKGROUND
  Cavernous hemangiomas account for 5%-13% of central nervous system vascular lesions. They are usually found intra-axially but rarely involve extra-axial structures, most commonly the middle cranial fossa. A cavernous hemangioma manifesting as a clinoid meningioma is extremely rare.
  
  
  METHODS
  A 36-year-old man presented with an asymptomatic intracranial mass found incidentally after a motor vehicle accident. Preoperative magnetic resonance imaging revealed a well-defined dural-based lesion arising from the right anterior clinoid process that was nearly homogeneously enhancing. The radiologic diagnosis was meningioma. The mass was resected via a right pterional craniotomy with microsurgical technique. Complete resection of the mass was performed with no complications and no significant bleeding. Contrasting with the radiologic and gross tumor appearance, histopathologic examination revealed dilated vascular spaces, sclerotic vessels without intervening neural tissue, and intravascular thrombi suggesting slow blood flow-all consistent with cavernous hemangioma.
  
  
  CONCLUSIONS
  Anterior clinoid dural-based cavernous hemangiomas are extremely rare. Although preoperative diagnosis is difficult using imaging, this etiology should be considered for any dural-based middle fossa lesion, owing to the tendency for these lesions to bleed heavily during resection in some instances.
authors.affiliation: Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Tarek R
authors.initials: TR
authors.lastname: Mansour
authors.affiliation: Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Yacine
authors.initials: Y
authors.lastname: Medhkour
authors.affiliation: Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
authors.forename: Pouya
authors.initials: P
authors.lastname: Entezami
authors.affiliation: Department of Pathology, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Mrak
authors.affiliation: Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Schroeder
authors.affiliation: Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA. Electronic address: azedine.medhkour@utoledo.edu.
authors.forename: Azedine
authors.initials: A
authors.lastname: Medhkour
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging*
keywords: Anterior clinoid mass; Dural tail sign; Extra-axial cavernous hemangioma; Meningioma; Pterional craniotomy