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Glioblastoma and intracranial aneurysms: Case report and review of literature.

Ali R, Pabaney A, Robin A, Marin H, Rosenblum M - Surg Neurol Int (2015)

Bottom Line: The authors present a case of a MCA pseudoaneurysm that developed in a patient with recurrent GBM and discuss the current literature.The treating physician should be aware of this association when patients with intraaxial tumors present with unusual manifestation such as an intratumoral hemorrhage or angiogram negative subarachnoid hemorrhage.No guidelines exist to assist in the management of such patients; therefore, authors have attempted to address this issue using a classification and treatment algorithm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.

ABSTRACT

Background: There is a paucity of data on the association of glioblastoma multiforme (GBM) with intracranial aneurysms. It is an important clinical entity for physicians to be aware of and its presence illustrates several critical features of the pathophysiology of malignant glioma. In this article we present a case of a middle cerebral artery (MCA) pseudoaneurysm that occurred in a patient with recurrent GBM as well discuss the current literature relating to this unique combination of pathologies.

Case description: The authors present a case of a MCA pseudoaneurysm that developed in a patient with recurrent GBM and discuss the current literature. The authors identified 19 reports describing 23 patients harboring both GBM and an intracranial aneurysm.

Conclusion: Several theories stand to explain the coincidental occurrence of intracranial aneurysms and GBM. The treating physician should be aware of this association when patients with intraaxial tumors present with unusual manifestation such as an intratumoral hemorrhage or angiogram negative subarachnoid hemorrhage. No guidelines exist to assist in the management of such patients; therefore, authors have attempted to address this issue using a classification and treatment algorithm.

No MeSH data available.


Related in: MedlinePlus

GBM and pseudoaneurysm. Pretreatment T1-weighted gadolinium-enhanced axial MRI demonstrating a heterogeneously enhancing mass in the right frontotemporal region extending into the right basal ganglia and internal capsule in 2005 (a). Posttreatment T1-weighted, gadolinium-enhanced coronal MRI of a cystic and nodular heterogeneously enhancing frontotemporal lesion extending from the middle fossa floor to the right basal ganglia in 2011 (b). Oblique AP (c) and oblique lateral (d) projections of a right internal carotid artery injection during a digital subtraction angiogram revealing the presence of a 2 cm, rapidly filling aneurysm with extremely irregular walls and no identifiable neck arising from the region of the right MCA trifurcation later in 2011
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Figure 1: GBM and pseudoaneurysm. Pretreatment T1-weighted gadolinium-enhanced axial MRI demonstrating a heterogeneously enhancing mass in the right frontotemporal region extending into the right basal ganglia and internal capsule in 2005 (a). Posttreatment T1-weighted, gadolinium-enhanced coronal MRI of a cystic and nodular heterogeneously enhancing frontotemporal lesion extending from the middle fossa floor to the right basal ganglia in 2011 (b). Oblique AP (c) and oblique lateral (d) projections of a right internal carotid artery injection during a digital subtraction angiogram revealing the presence of a 2 cm, rapidly filling aneurysm with extremely irregular walls and no identifiable neck arising from the region of the right MCA trifurcation later in 2011

Mentions: A 63-year-old right-handed male presented to the hospital with headaches and dizziness. His neurological examination was normal except for mild left hand ataxia. A magnetic resonance imaging (MRI) of the brain demonstrated a heterogeneously enhancing mass in the right frontotemporal region extending into the right basal ganglia and internal capsule [Figure 1a]. He underwent subtotal resection via a right frontotemporal craniotomy. Pathology was consistent with anaplastic oligodendroglioma. He completed a course of fractionated external beam radiation and concurrent temozolomide followed by adjuvant temozolomide. Subsequently he progressed and underwent second-line chemotherapy with Bevacizumab and Irinotecan followed by sterotactic radiosurgery (SRS) to the right frontotemporal region. Several years later, progressive enhancement was discovered on routine surveillance imaging and the patient underwent reresection [Figure 1b]. Intraoperatively, branches of the right MCA were found to be intimately associated with tumor-like tissue. The middle cerebral vessels were carefully skeletonized, but several areas of tissue were densely adherent to the MCA and therefore, some residual tumor-like tissue was left behind. Subsequent pathologic examination revealed radiation necrosis with no evidence of tumor recurrence and the patient was discharged in a stable condition. Several weeks later, the patient returned to our emergency department, Glascow Coma Scale of 6 and with extensor posturing on neurological examination. Computed tomography (CT) of the head revealed an extensive area of acute hemorrhage predominantly involving the tumor resection bed with dissection into the ventricular system. An external ventricular drain was placed and the patient underwent emergent cerebral angiography. The angiogram displayed a 2 cm, rapidly filling aneurysm with extremely irregular walls and no identifiable neck arising from the region of the right MCA trifurcation [Figure 1c and d]. Given the patient's poor neurological status and advanced malignant glioma, aggressive therapies were not pursued and the patient died 3 days later.


Glioblastoma and intracranial aneurysms: Case report and review of literature.

Ali R, Pabaney A, Robin A, Marin H, Rosenblum M - Surg Neurol Int (2015)

GBM and pseudoaneurysm. Pretreatment T1-weighted gadolinium-enhanced axial MRI demonstrating a heterogeneously enhancing mass in the right frontotemporal region extending into the right basal ganglia and internal capsule in 2005 (a). Posttreatment T1-weighted, gadolinium-enhanced coronal MRI of a cystic and nodular heterogeneously enhancing frontotemporal lesion extending from the middle fossa floor to the right basal ganglia in 2011 (b). Oblique AP (c) and oblique lateral (d) projections of a right internal carotid artery injection during a digital subtraction angiogram revealing the presence of a 2 cm, rapidly filling aneurysm with extremely irregular walls and no identifiable neck arising from the region of the right MCA trifurcation later in 2011
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4418170&req=5

Figure 1: GBM and pseudoaneurysm. Pretreatment T1-weighted gadolinium-enhanced axial MRI demonstrating a heterogeneously enhancing mass in the right frontotemporal region extending into the right basal ganglia and internal capsule in 2005 (a). Posttreatment T1-weighted, gadolinium-enhanced coronal MRI of a cystic and nodular heterogeneously enhancing frontotemporal lesion extending from the middle fossa floor to the right basal ganglia in 2011 (b). Oblique AP (c) and oblique lateral (d) projections of a right internal carotid artery injection during a digital subtraction angiogram revealing the presence of a 2 cm, rapidly filling aneurysm with extremely irregular walls and no identifiable neck arising from the region of the right MCA trifurcation later in 2011
Mentions: A 63-year-old right-handed male presented to the hospital with headaches and dizziness. His neurological examination was normal except for mild left hand ataxia. A magnetic resonance imaging (MRI) of the brain demonstrated a heterogeneously enhancing mass in the right frontotemporal region extending into the right basal ganglia and internal capsule [Figure 1a]. He underwent subtotal resection via a right frontotemporal craniotomy. Pathology was consistent with anaplastic oligodendroglioma. He completed a course of fractionated external beam radiation and concurrent temozolomide followed by adjuvant temozolomide. Subsequently he progressed and underwent second-line chemotherapy with Bevacizumab and Irinotecan followed by sterotactic radiosurgery (SRS) to the right frontotemporal region. Several years later, progressive enhancement was discovered on routine surveillance imaging and the patient underwent reresection [Figure 1b]. Intraoperatively, branches of the right MCA were found to be intimately associated with tumor-like tissue. The middle cerebral vessels were carefully skeletonized, but several areas of tissue were densely adherent to the MCA and therefore, some residual tumor-like tissue was left behind. Subsequent pathologic examination revealed radiation necrosis with no evidence of tumor recurrence and the patient was discharged in a stable condition. Several weeks later, the patient returned to our emergency department, Glascow Coma Scale of 6 and with extensor posturing on neurological examination. Computed tomography (CT) of the head revealed an extensive area of acute hemorrhage predominantly involving the tumor resection bed with dissection into the ventricular system. An external ventricular drain was placed and the patient underwent emergent cerebral angiography. The angiogram displayed a 2 cm, rapidly filling aneurysm with extremely irregular walls and no identifiable neck arising from the region of the right MCA trifurcation [Figure 1c and d]. Given the patient's poor neurological status and advanced malignant glioma, aggressive therapies were not pursued and the patient died 3 days later.

Bottom Line: The authors present a case of a MCA pseudoaneurysm that developed in a patient with recurrent GBM and discuss the current literature.The treating physician should be aware of this association when patients with intraaxial tumors present with unusual manifestation such as an intratumoral hemorrhage or angiogram negative subarachnoid hemorrhage.No guidelines exist to assist in the management of such patients; therefore, authors have attempted to address this issue using a classification and treatment algorithm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.

ABSTRACT

Background: There is a paucity of data on the association of glioblastoma multiforme (GBM) with intracranial aneurysms. It is an important clinical entity for physicians to be aware of and its presence illustrates several critical features of the pathophysiology of malignant glioma. In this article we present a case of a middle cerebral artery (MCA) pseudoaneurysm that occurred in a patient with recurrent GBM as well discuss the current literature relating to this unique combination of pathologies.

Case description: The authors present a case of a MCA pseudoaneurysm that developed in a patient with recurrent GBM and discuss the current literature. The authors identified 19 reports describing 23 patients harboring both GBM and an intracranial aneurysm.

Conclusion: Several theories stand to explain the coincidental occurrence of intracranial aneurysms and GBM. The treating physician should be aware of this association when patients with intraaxial tumors present with unusual manifestation such as an intratumoral hemorrhage or angiogram negative subarachnoid hemorrhage. No guidelines exist to assist in the management of such patients; therefore, authors have attempted to address this issue using a classification and treatment algorithm.

No MeSH data available.


Related in: MedlinePlus