Dural-Based Cavernous Malformation at the Cerebral Convexity: Report of Two Pediatric Patients

Intracranial cavernous malformations (CMs) are usually located at the cerebral parenchyma; dural-based CMs outside the middle fossa are rarely reported. To our knowledge, dural-based CMs located at the cerebral convexity are even rarer in that only 2 pediatric cases have ever been reported. In this report, we present 2 extremely rare cases of dural-based CMs at the cerebral convexity in pediatric patients. The clinical course, radiologic and pathologic features, treatment, and follow-up are described.

The first case is a 6-year-old boy who presented with headache and vomiting and was found to have an acute subdural hematoma and space-occupying lesion. Intraoperative findings and histologic examination were consistent with a CM. He experienced an uneventful postoperative recovery. The second case is a 43-day-old female neonate who presented with a progressively enlarging neoplasm at the right occipital region since birth. Computed tomography of the head performed at admission showed a slight hyperdense occupying lesion communicating between the intra- and extracranial cavity through a skull defect. The lesion was resected en bloc and histologic examination was in accord with a CM.

The clinical manifestations and radiologic characteristics of dural-based CMs are nonspecific. Unlike that of their cerebral parenchymal counterparts, the radiologic appearance of dural-based CMs is confusing and misleading. Surgical resection is the primary treatment selection for dural-based CMs. In cases with no close relationship to dural sinuses, complete surgical resection with minimal blood loss and few neurologic deficits could be easily achieved.