[A case of extracerebral cavernous hemangioma in the middle fossa]

Authors reported an autopsy case of extracerebral cavernous hemangioma in the middle fossa and discussed the effect of irradiation therapy on it. A 72-year-old woman was admitted due to progressive deterioration of consciousness and the right hemiparesis. CT scan revealed a slightly high density mass, which was markedly heterogeneously enhanced with contrast media, in the left middle cranial fossa. Angiogram with prolonged injection demonstrated a faint tumor stain. Craniectomy and partial temporal lobectomy for decompression were performed, but the tumor could not be removed due to uncontrollable hemorrhage. Her level of consciousness further deteriorated, and in addition heart failure developed. And finally she became vegetative in spite of effective irradiation therapy of 46Gy. CT scan taken three months and seven years after the irradiation showed marked regression of the tumor. After the vegetative state for 8 years, the patient died of acute pancreatitis, and autopsy was performed. The cavernous hemangioma with markedly proliferated interstitial connective tissue and thrombosed vessels was verified by microscopical examination. Although the treatment was not successful in this patient, we confirmed that irradiation is useful in the management of the extra-axial cavernous hemangioma in the middle fossa as a pre- or postoperative adjunct therapy.