Dural Cavernous Angioma of the Cerebellopontine Angle: Case Report and Review of the Literature

Background: Dural cavernous angiomas (DCAs) are uncommon vascular tumors that are pathologically and radiographically distinct from parenchymal cavernous angiomas. Those that involve the internal auditory canal (IAC) are particularly rare with only 47 cases ever reported in the literature in our review. Only four cases of DCAs with a predominant cerebellopontine angle (CPA) component have been described. Recognition of these cases preoperatively presents a challenge as they are often clinically and radiographically indistinguishable from vestibular schwannoma (VS) or facial nerve schwannoma (FNS). Patients commonly present with hearing loss along with facial weakness or hemifacial spasm. Surgical intervention on unsuspected DCAs may result in uncontrollable hemorrhage and facial nerve compromise, often requiring facial reanimation. Here, we present a case of recurrence of dural cavernous angioma of the cerebellopontine angle after initial resection. This is the first known report of a DCA primarily involving the CPA that recurred following initial gross total resection, highlighting the potentially aggressive nature of these lesions and the importance of long-term follow-up.

Methods: Case report.

Results: A 26-year-old man presented with hearing loss and complete facial weakness and underwent reported gross total resection of a DCA involving the CPA at an outside institution. He recovered with back-to-normal hearing and facial function. Follow-up imaging at 2 years postoperatively showed no evidence of recurrence. A small recurrence was seen at 4 years following the initial operation; however, he was asymptomatic and lost to further follow-up. He again presented 7 years after the original operation to the Mayo Clinic with return of complete left-sided hearing loss and left facial weakness and a large recurrence was found. He subsequently underwent gross total resection through a translabyrinthine approach with facial-hypoglossal anastomosis for facial reanimation.

Conclusions: Dural cavernous angiomas of the IAC/CPA are rare lesions that are sometimes indistinguishable from VS or FNS. This is the fifth report of dural cavernous angioma predominantly involving the cerebellopontine angle and the first report of recurrence following a reported gross total resection. Careful long-term follow-up is imperative in these patients as tumors may aggressively recur warranting further treatment.