Teaching Video NeuroImage: Dural Angioleiomyoma: Insights From Dynamic Imaging.

A 47-year-old man with an unremarkable medical history presented with mild dull occipital headaches for 7 months, without other neurologic changes. Structural MRI showed an extraparenchymal, well-delineated left cerebellar lesion with partial postgadolinium enhancement (Figure). Exploration with T1-weighted perfusion (Video 1) revealed a progressive, centrifugal enhancement pattern with slow contrast filling, rapid near the center but slower toward outer edges, suggesting a benign mesenchymal tumor. The absence of mass effect and cerebellar symptoms further supported a slow-growing tumor. A surgical removal was performed. Neuropathologic examination revealed a well-circumscribed lesion with smooth muscle cells and vascular cavities, indicating dural angioleiomyoma (Figure). Dural angioleiomyoma is a rare benign tumor, with <80 cases reported in a recent literature review1 related to soft tissue angioleiomyomas. Partial and flame-like enhancement arising from the tumor base and extending to its periphery seems to be the most typical imaging characteristic,2 and dynamic contrast-enhanced sequence may aid in envisioning diagnosis preoperatively.