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.