Intracranial infratentorial angioleiomyoma, an unusual localisation

We report a rare case of a dural angioleiomyoma (ALM) in a woman in her 50s presenting with a progressive right-sided tremor. MRI revealed a left-sided infratentorial extra-axial lesion, initially suspected to be a posterior fossa meningioma. The patient underwent supracerebellar infratentorial gross total resection without complications. Histopathology demonstrated well-differentiated spindle-shaped smooth muscle cells arranged around blood vessels, with strong smooth muscle actin positivity and a Ki-67 index <1%, confirming the diagnosis of dural ALM. At the 1-year follow-up, the patient remained neurologically intact and imaging showed no recurrence.Intracranial ALMs are exceedingly rare and often misdiagnosed preoperatively due to non-specific imaging characteristics. This case highlights the importance of considering ALM in the differential diagnosis of extra-axial posterior fossa lesions and emphasises that complete surgical excision provides excellent disease control with favourable functional outcomes.