Extra-Axial Dural-based Cavernous Hemangioma of Skull Base in a 15-year-old Male: A tale of complex case with favorable outcome

Middle cranial fossa hemangiomas are challenging owing to the complex vascular anatomy of the region. Only few cases have been reported to date, in our setting. A 15-year-old male presented with the headache, right sided visual deterioration for 18 months. He had right pupil dilated, non-reactive, ptosis and ophthalmoplegia. Magnetic resonance imaging (MRI) revealed right middle fossa heterogeneous enhancing lesion. On angiography, internal carotid artery (ICA) showed cavernous segment blush. Digital subtraction angiography was suggestive of diminutive right ICA; no distal filling beyond its cavernous segment. Patient was re-operated, excision was done. Intraoperatively lesion was extra-axial and highly vascular. Histopathology was conclusive of OLIG2 and SSTR2 negative hemangioma. Post-operative recovery was uneventful. While probing the differentials of skull base lesions, especially near ICA, cavernous sinus hemangiomas must be considered. Although extremely rare but the vascular nature poses a threat to life, if not meticulously investigated and operated timely.