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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 2  |  Page : 250-252

Intradiploic ossified giant cavernous hemangioma of skull with a dural tail sign mimicking primary calvarial meningioma


Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India

Date of Submission03-Jan-2012
Date of Decision03-Jan-2012
Date of Acceptance22-Jan-2012
Date of Web Publication19-May-2012

Correspondence Address:
Ashis Patnaik
Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.96431

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How to cite this article:
Patnaik A, Mishra SS, Mishra S, Deo RC. Intradiploic ossified giant cavernous hemangioma of skull with a dural tail sign mimicking primary calvarial meningioma. Neurol India 2012;60:250-2

How to cite this URL:
Patnaik A, Mishra SS, Mishra S, Deo RC. Intradiploic ossified giant cavernous hemangioma of skull with a dural tail sign mimicking primary calvarial meningioma. Neurol India [serial online] 2012 [cited 2021 Sep 20];60:250-2. Available from: https://www.neurologyindia.com/text.asp?2012/60/2/250/96431


Sir,

Cavernous hemangioma of the skull is rare and accounting for 0.2% of benign skull lesions with peak incidence in the fourth or fifth decade. These lesions grow between the outer and inner tables of the skull, are usually solitary, and typically occur in the frontal or parietal bones. They are supplied by the branches of the external carotid artery in the diploic space. Intradiploic hemangiomas usually erode the outer table of the skull and despite tumour enlargement, inner table remains intact. [1] We present a young patient with pure intradiploic cavernous hemangioma with erosion of both inner and outer tables of skull.

A 27-year-old man presented with a large hard left frontal swelling. Computed tomography (CT) of skull showed a large, expansile lesion destroying both inner and outer tables of the skull. The lesion had a larger intracranial component with mass effect and showing homogenous, intense enhancement with contrast [Figure 1]a and b. Magnetic resonance imaging (MRI), in addition to the above features, showed the lesion to be purely intradiploic having both extra- and intracranial extension. The adjoining dura showed a characteristic enhancement, dural tail sign [Figure 1]c. The bone window showed gross calcification of the lesion. The pre-operative diagnosis was meningioma. On MR venography, the mass was indenting the superior sagittal sinus however, the patency was intact. Intra-operatively the finding was of a large expansile, vascular, hard and gritty lesion with dural attachment suggestive of a primary calvarial meningioma [Figure 1]d and e. Histologically the lesion showed features cavernous hemangioma [Figure 1]f.
Figure 1: a: CT scan showing a primary skull lesion having a large intracranial and a smaller extracranial component
Figure 1: b: CT bone window showing areas of ossification
Figure 1: c: Contrast MRI showing the characteristic dural tail sign (black arrow)
Figure 1: d: The excised tumour with attached dura
Figure 1: e: Bony hard consistency with a gritty feeling on cutting the lesion
Figure 1: f: Histopathology showing dilated sinusoids suggestive of cavernous hemangioma


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Osseous hemangiomas of the calvaria are rare and can present in a varied way radiologically, thereby making the pre-operative diagnosis difficult. We could find only one such report of intradiploic cavernous hemangioma showing dural tail in the literature. [2] These benign tumours of skull can be completely cured with en-bloc excision. Curettage alone is not sufficient and may cause tumor recurrence and excessive blood loss. Our patients suggests that osseous hemangiomas of the skull should be considered in the differential diagnosis of skull bone tumors, even if the clinico-radiologic features may be suggestive of another type of pathology. This could help in management planning, particularly the role of pre-operative embolisation in the treatment of these lesions.

 
  References Top

1.Suzuki Y, Ikeda H, Matsumoto K. Neuroradiological features of intraosseous cavernous haemangioma-case report. Neurol Med Chir (Tokyo) 2001;41:279-82.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Politi M, Romeike BF, Papanagiotou P, Nabhan A, Struffert T, Feiden W, et al. Intraosseous Hemangioma of the Skull with Dural Tail Sign: Radiologic Features with Pathologic Correlation. Am J Neuroradiol 2005;26:2049-52.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  


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