Cranioplasty after Two Giant Intraosseous Angiolipomas of the Cranium: Case Report and Literature Review

Abstract

Angiolipomas are rare, benign tumors resulting from the proliferation of adipose tissue and blood vessels, most frequently encountered subcutaneously at the upper limbs and trunk level. Due to their rarity, few cases of intraosseous angiolipomas are presented in the literature. The paper reports a 50-year-old female case with intracranial hypertension syndrome, frontal and parietal headache, nausea, and vomiting symptoms increasing in intensity. A CT exam revealed two hypodense expansive intraosseous formations/lesions. The first one was located in the projection of the frontal bone and the second one was placed on the left parietal bone. After further investigations, a two-stage procedure was considered. A frontal craniotomy with excision of the intraosseous tumor was performed in the first stage. In the second stage, a left parietal craniotomy was done with excision of the intraosseous tumor combined with a cranioplasty procedure. The patient had a favorable postoperative evolution with no symptoms or neurological deficits. This is among the few reported cases of intraosseous angiolipoma located at the cranium level and the first case report of two intraosseous angiolipomas situated on the same site. The medical recommendation was a complete surgical excision of the lesion followed by cranioplasty.

Keywords: bone tumor; cranioplasty; craniotomy; cranium; intraosseous angiolipoma; rare disease; two stage surgical procedure.

Figure 1

Preoperative neuroimaging: (A) Sagittal MRI scan showing the frontal lesion. (B) Axial MRI scan showing both the frontal and the parietal lesions. (C) Coronal MRI scan showing the parietal lesion. (D) Axial CT scan highlighting the hypodense aspect of frontal and parietal osseous lesions.

Figure 2

(A) Left frontoparietal craniotomy. (B) Titanium mesh with titanium monoaxial screws clamping system. (C) The aspect of applied titanium mesh. (D) PMMA cementation over titanium mesh.

Figure 3

Postoperative neuroimaging: (A) Axial CT scan. (B) Sagittal radiographic scan.

Figure 4

Microscopical images related to the histological investigation—general aspects of the tissue, hematoxylin and eosin (H&E) section: (A) Tumoral proliferation formed of venous blood vessels and trabecular bone tissue (H&E, ×4 original magnification); (B) bone lamellae replaced by proliferation of blood vessels in a myxoid matrix (H&E, ×10 original magnification); (C) bone lamellae that present a row of osteoblasts on the edge and a sanguine vessel of venous type disposed in a myxoid matrix (H&E, ×20 original magnification).

Figure 5

Microscopical images related to some details obtained during the histological investigation—hematoxylin and eosin (H&E) section: (A) Dilated blood vessel that replace the hematogenous marrow (×10 original magnification); (B) areas with hemorrhagic necrosis located in an angiolipomatous formation (H&E, ×4 original magnification).

Figure 6

Microscopical images related to the proliferation of blood vessels obtained during the histological investigation—Masson’s trichrome section: (A) Blood vessels proliferation in trabecular bone tissue (×4 original magnification); (B) dilated venous blood vessel with red blood cells (RBCs) present in the lumen (×10 original magnification).