• Ariana Adamski, Jiang Qian, and Matthew A Adamo.
• Albany Medical College, Albany, New York, USA. Electronic address: adamska@amc.edu.
• World Neurosurg. 2020 Sep 1; 141: 3-7.

BackgroundExtraaxial cavernous hemangiomas (EACHs) are an extremely rare form of cerebral vascular malformations, occurring infrequently in children and rarely exceeding 6.0 cm in diameter (labeled as "giant"). Our case study highlights the radiographic, diagnostic, and interventional uncertainties in the management of giant EACHs in a pediatric population.Case DescriptionOur patient, a 15-year-old male with 3-month history of hemiparetic symptoms, was shown to have a 9.0-cm extraaxial parietal-occipital mass upon imaging. Differential diagnosis included cavernoma versus meningioma because of similarities in imaging presentation. Pathologic confirmation of EACH was achieved after resection, and the patient experienced positive outcomes including total recovery from his hemiparesis.ConclusionsEACHs are difficult to characterize radiographically and are often mistaken to be meningiomas before resection and pathologic confirmation. Therefore cavernous hemangiomas should be considered in the differential diagnosis of pediatric extraaxial masses. Additionally, preoperative hemorrhage control efforts should be pursued to reduce adverse outcomes stemming from resection of vascular malformations such as EACHs.Copyright © 2020 Elsevier Inc. All rights reserved.

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