Two Cystic Cavernous Angiomas after Radiotherapy for Atypical Meningioma in Adult Woman : Case Report and Literature Review
A 49-year-old, Latin American, right handed, woman, at the age of 39 consulted for progressive swelling of the left frontal region. Magnetic Resonance (MR) scanning showed an intradiploic mass with dural attachment (). A Simpson I removal was achieved at the first operation; on histological examination () the diagnosis was atypical meningioma (World Health Organization II).\nThe patient received 6000 cGy of Fractionated Stereotactic Radiotherapy. Chemotherapy was not delivered. The patient was followed up neurologically and radiologically. Follow-up MR imaging did not reveal any recurrence of the tumour or other lesions.\nNine years later, at the age of 48, follow-up MR imaging showed two new well defined areas, with cystic and necrotic components, at the surface of each frontal pole. The lesions appeared isointense-hypointense on T1-weighted sequences, with heterogeneous gadolinium enhancement, and hyperintense on T2-weighted. Clinical examination was normal. The following year, at the age of 49, she presented to the emergency unit of our department with drug-resistant headache. MR imaging showed that both lesions had grown. The largest one (5.5×3.6 cm), in the left frontal lobe, was a large gliotic bordered lobulated lesion, with a big cystic component, that extended from the frontal pole to the frontal horn of lateral ventricle. The right lesion (3.7×2.4 cm), with a smaller cystic component, was entirely within the right pole (, ). Bilateral frontal craniotomy was performed to remove both the masses. The histopathological diagnosis was cavernous angioma (). The lesion was composed of hyalinized vascular channels, with different calibers. The vessels were thick and amuscular and the brain parenchyma interposed between the channels showed gliosis. The patient had not family history of cavernomas. After surgical removal, symptomatology completely remitted.