Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. stain. 2 Generally, tentorial CAs could be supplied by feeders such as meningeal branches of vertebro-basilar arteries and branches of external carotid arteries. 6,9 The present case showed almost the same findings as those in the tentorial CAs described previously, except for spontaneous hemorrhage; however, preoperatively, we misdiagnosed it as a hypervascular brain tumor, such as a meningioma or heman- giopericytoma. Hence, although rare, in the differential diagnosis of tentorium-based tumors, including meningiomas and hemangioper- icytomas, tentorial CA should be considered. The treatment of choice for tentorial CAs is total surgical removal. 2 Preoperative embolization of the feeders was suggested for maximum safe resection with minimal blood loss. 6 In addition, as intracranial extra-axial CAs are more radiosensitive than intra- axial CAs, 10 in patients of a partial removal or biopsy with histological confirmation, radiotherapy is recommended as it could obtain a marked shrinkage of the tumor. 2 In conclusion, although extremely rare, tentorial CAs could present with spontaneous hemorrhage, and they might be easily misdiagnosed as other tentorium-based hypervascular brain tumors. Preoperative embolization of the feeders was suggested for maxi- mum safe resection with minimal blood loss. In patient of partial removal, radiotherapy is effective to shrink the tumor. Xiaodong Shi, MD Qiyong Jiang, MD Xiaogang Liu, MD Xunhui Yuan, MD Gaoling Sun, MD Department of Neurosurgery Yidu Central Hospital of Weifang Qingzhou, China Jianyi Niu, MD Department of Neurology Yidu Central Hospital of Weifang Qingzhou, China Liemei Guo, MD, PhD Department of Neurosurgery, Renji Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China guolm001@126.com REFERENCES 1. Kim JS, Yang SH, Kim MK, et al. Cavernous angioma in the falx cerebri: a case report. J Korean Med Sci 2006;21:950–953 2. Melone AG, Delfinis CP, Passacantilli E, et al. Intracranial extra-axial cavernous angioma of the cerebellar falx. World Neurosurg 2010;74:501–504 3. Di Vitantonio H, De Paulis D, Ricci A, et al. Cavernous hemangioma of the dura mater mimicking meningioma. Surg Neurol Int 2015;6 (suppl 13):S375–S378 4. Gutierrez-Gonzalez R, Casanova-Peno I, Porta-Etessam J, et al. Dural cavernous haemangioma of the anterior cranial fossa. J Clin Neurosci 2010;17:936–938 5. Eisenberg MB, Al-Mefty O, DeMonte F, et al. Benign nonmeningeal tumors of the cavernous sinus. Neurosurgery 1999;44:949–954 6. Yoshimura J, Tsukamoto Y, Sano M, et al. Successful removal of a huge hypervascular tentorial cavernous angioma after preoperative endovascular embolization. J Neurosurg Pediatr 2014;14:43–47 7. Lewis AI, Tew JM Jr, Payner TD, et al. Dural cavernous angiomas outside the middle cranial fossa: a report of two cases. Neurosurgery 1994;35:498–504 8. Bhatia S, O’Neill BR, Pu F, et al. Giant tentorial cavernous hemangioma: case report and review of literature. Clin Neurol Neurosurg 2011;113:937–942 9. Rhoton AL Jr. Tentorial incisura. Neurosurgery 2000;47 (3 suppl):S131–S153 10. Seo Y, Fukuoka S, Sasaki T, et al. Cavernous sinus hemangioma treated with gamma knife radiosurgery: usefulness of SPECT for diagnosis—case report. Neurol Med Chir 2000;40:575–580 Saccular Aneurysm of Internal Jugular Vein in a Young Patient To the Editor: A venous aneurysm is defined as an isolated zone of venous dilatation that communicates with a main venous structure by a single channel. 1 Unrelated to either age or gender, it can affect any vein but due to low pressure in the vena cava system, aneurysms of cervical veins are rare. Saccular aneurysms of the internal jugular vein in young ages are extremely rare. 2 Internal jugular venous aneurysms usually present as a painless neck swelling that is a common symptom in various diseases of children. Therefore, it may pose a diagnostic dilemma. In this report, we presented a young patient with saccular internal jugular venous aneurysm. A 4-year-old female presented with a 9-month history of a painless swelling at right neck region. On physical examination, a soft, painless mass starting from right submandibular region and extending toward right supraclavicular region, 6  4 cm in diameter was observed. An ultrasonography revealed a cystic mass that is suspected to be a branchial cleft cyst. A magnetic resonance imaging of the neck was performed which revealed a macrolobu- lated cystic mass starting from inferior of right parotid gland extending toward supraclavicular region through posterior of sternocleidomastoid muscle, 7  5  5 cm in diameter. The mass was hyperintens in T2-weighted images and iso-hyperintens in T1-weighted images (Fig. 1). An operation for excision of the mass was planned. During the operation it was observed that the mass was bluish-gray in color. Careful dissection of the mass revealed a connection between the mass and internal jugular vein. The mass was diagnosed as saccular aneurysm of internal jugular vein. In association with cardiovascular surgery, the mass was fully excised. The histopathological evaluation confirmed the diagnosis of saccular aneurysm. The postoperative period was uneventful. Saccular aneurysm of internal jugular vein is extremely rare with only a few reports in English literature. 2 Because of the presence of FIGURE 1. MRI shows a macrolobulated cystic mass starting from inferior of right parotid gland extending toward supraclavicular region. The mass was hyperintens in T2-weighted images and iso-hyperintens in T1-weighted images. A, T2 weighted image. B, T1 weighted image. Correspondence The Journal of Craniofacial Surgery  Volume 28, Number 3, May 2017 850 # 2017 Mutaz B. Habal, MD