PMC4109172_01
MRI of the CCM and OCH pre- and post-resection (at 3-year follow-up). (a) Axial T2 MRI showing left temporal heterogeneous popcorn lesion (arrow) extending into the atrium of the left occipital horn of the lateral ventricle consistent with a CCM. A left orbital lesion consistent with an orbital hemangioma is also visualized (arrowhead). (b) Coronal T2 image showing OCH. (c) Sagittal T1 image showing the CCM and OCH before resection. (d-f) Axial T2, coronal T2, and sagittal T1 MRIs post-resection demonstrating complete resection of the CCM and OCH
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F1
Neuroimaging revealed a 15-mm hemorrhagic mass in the left temporo-occipital region consistent with a CCM and a significant residual left OCH measuring approximately 30 mm [Figure 1a-c]. Interval MRI demonstrated that the left orbital mass had increased in size, consistent with recurrence of the left orbital tumor that was resected 30 years before [Figure 1]. MRI showed typical postsurgical changes at each operative site with no new abnormal signal or enhancement suggestive of recurrence, additional lesions, or hemorrhage [Figure 1d-f].
Intraoperative images of the OCH resection. Pathology was resected utilizing an incision along the lid crease. An operative window was created with an extended lateral orbital bone flap
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F2
Following induction of generalized anesthesia, the ophthalmology team made an incision at the upper lid crease and proceeded to dissect superiorly in the plane between the orbicularis muscle and orbital septum [Figure 2].
(a, b) CCM comprised cavernous, endothelium-lined vascular sinusoids with foci of calcification (a) and ossification. (b) Little intervening brain tissue between the cavernous vessels was noted. (c) High-power view of the vascular walls of the CCM demonstrates delicate mural hyalinization, scattered extravasated erythrocytes and hemosiderin, and scant inflammation. (d) Brain parenchyma at the periphery of the lesion showing typical hemosiderin deposits, macrophages, axonal spheroids, and gliosis
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F3
Histopathologic review confirmed the working diagnosis of recurrent OCH [Figure 3].