DURAL CAVERNOUS ANGIOMAS OUTSIDE THE MIDDLE CRANIAL FOSSA - A REPORT OF 2 CASES

CAVERNOUS ANCIOMAS OF the dura mater are clinically and radiographical ly distinct from parenchymal cavernous angiomas. In this report, we pr esent two cases of dural cavernous angiomas located outside the middle cranial fossa. The first patient is a 36-year-old woman with two dura l cavernous angiomas, including one that enlarged during a 2-year peri od of observation. The second patient is a 33-year-old man with medica lly intractable seizures from a dural cavernous angioma of the convexi ty, which was discovered at autopsy. From our experience and a review of the literature, we have identified two groups of dural cavernous an giomas that differ in incidence, natural history, and surgical managem ent. Most dural cavernous angiomas arise from the middle fossa; in con trast, only 15 cases of dural cavernous angiomas outside the middle fo ssa have been reported. Those in the middle fossa are more clinically aggressive and more difficult to resect surgically, because they grow toward the cavernous sinus and the parasellar region. Most patients wi th dural cavernous angiomas outside the middle fossa present with head aches, whereas those patients with dural cavernous angiomas in the mid dle fossa present with ocular signs, visual field defects, endocrinopa thy, and trigeminal symptoms. Radiographically, both of the angiomas r esemble meningiomas. Because of their intimate association with the ca vernous sinus, surgical resection of middle fossa cavernous angiomas o ften is incomplete and may require postoperative radiosurgery to contr ol growth. In contrast, angiomas in other locations are easily and suc cessfully resected with little blood loss, The location of dural caver nous angiomas is an important factor in making the surgical decision a nd in predicting the outcome.