A child dural-based occipital cavernoma with an accessory venous sinus

Abstract

Background: The diagnosis of extra-axial cavernoma and surgical decision-making can be difficult on children.

Reported case: In this report we present the case of a 33-month-old child for whom the work up done for asthenia, anorexia and psychomotor regression reveals a well-defined occipital extra-axial lesion. A follow up MRI was performed two months later, revealing an increase in the size of the lesion associated with hemorrhagic changes. The surgical decision is performed after an arteriography; it allows the total removal of the lesion contained in a duplication of the dura mater, by placing a vascular clip on an accessory venous sinus draining the lesion, respecting the integrity of the lateral sinus. Histology confirms a cavernoma. No complication resulted from the surgical procedure. This atypical case of pediatric dural cavernoma associated with a well-defined accessory venous sinus in arteriography is to our knowledge the first description in the literature.

Conclusion: Extra-axial cavernomas have a misleading presentation. The management of these lesions is of twofold interests: to avoid a repercussion on the development of these children, and to obtain histological confirmation.

Keywords: Accessory venous sinus; Cavernoma; Cavernome; Cavernome dural; Cavernous angioma; Cavernous hemangioma; Cavernous malformation; Child; Dura mater; Dural cavernoma; Dure-mère; Enfant; Hémangiome caverneux; Neurochirurgie pédiatrique; Pediatric neurosurgery; Sinus veineux accessoire.