Minimally Invasive Approaches to Treat Simultaneous Occurrence of Glioblastoma Multiforme and Intracranial Aneurysm - Case Report

Abstract

Primary brain tumors associated with intracranial aneurysm are rare. A combination of glioblastoma multiforme (GBM) with cerebral aneurysm is even more rare. We present a 67-year-old female, who suffered from progressive weakness of the right limbs and dysphasia for 2 days. She was referred from another hospital with impression of having a brain tumor. The non-enhanced computed tomographic (CT) scan of the brain showed a mass lesion over the left parietal region, and another tiny lesion with relatively high density over the left suprasellar region. After admission, the carotid angiogram revealed a 13 × 12 × 14 mm aneurysm with a base about 8 mm from the anterior wall of the left supraclinoid internal carotid artery (ICA) between the left ophthalmic artery and the left anterior choroid artery. We first clipped the aneurysm by a basal pterion keyhole approach. One week later, the tumor was en bloc removed by a small left parietal craniotomy under the guidance of a navigator. The final diagnosis was confirmed by histopathological examination as GBM. After the surgeries, the patient received palliative radiotherapy with a dose of 4000 cGy. She recovered well with no evidence of recurrence of the tumor one year after the operations. In this report, the careful diagnosis and the possible mechanisms of concurring GBM and cerebral aneurysm, as well as the strategies of surgical treatment involving minimally invasive approaches are discussed.

Key words

Aneurysm - glioblastoma multiforme (GBM) - keyhole - navigator

References

• 1 Handa J, Matsuda I, Handa H. Association of brain tumor and intracranial aneurysms.  Surg Neurol. 1976;  6 25-29
• 2 Ishibashi A, Shirouzu T, Nakashima H. et al . Coincidence of a brain tumor and a cerebral arterial aneurysm - report of a case and review of the literature.  Kurume Med J. 1984;  31 229-233
• 3 Pia H W, Obrador S, Martin J G. Association of brain tumours and arterial intracranial aneurysms.  Acta Neurochir (Wien). 1972;  27 189-204
• 4 Taylor P E. Delayed postoperative hemorrhage from aneurysm after craniotomy for tumor.  Neurology. 1961;  11 225-231
• 5 Yamada H, Taomoto K. Postoperative subarachnoid hemorrhage from an intracranial aneurysm after craniotomy for astrocytoma - case report.  Neuro Med Chir (Tokyo). 1989;  29 846-849
• 6 Andrews B T, Raffel C, Rosegay H. Subarachnoid hemorrhage from a peripheral intracranial aneurysm associated with malignant glioma: report of a case.  Neurosurgery. 1985;  17 645-649
• 7 Barker C S. Peripheral cerebral aneurysm associated with a glioma.  Neuroradiology. 1992;  34 30-32
• 8 Boop F A, Chadduck W M, Sawyer J. et al . Congenital aneurysmal hemorrhage and astrocytoma in an infant.  Pediatr Neurosurg. 1991 - 1992;  17 44-47
• 9 Cai X J, Zhang Y J, Hu K S. et al . A case of glioma in brain accompanied by an intracranial aneurysm.  Chin Med J (Engl). 1990;  103 683-685
• 10 Gokalp H Z, Avman N, Ozkal E. et al . Brain tumor associated with intracranial arterial aneurysm.  Acta Neurochir (Wien). 1980;  53 267-273
• 11 Licata C, Pasqualin A, Freschini A. et al . Management of associated primary cerebral neoplasms and vascular malformations: 1. Intracranial aneurysms.  Acta Neurochir (Wien). 1986;  82 28-38
• 12 Okamura T, Watanabe Y, Kameda H. et al . Coexistence of brain tumors and cerebral aneurysms. Clinical considerations from eight cases.  Neurol Med Chir (Tokyo). 1981;  21 601-608
• 13 Paoletti P, Rodriguez-y-Baena R, Sangiovanni G. et al . Association of a malignant glioma and an aneurysm of the middle cerebral artery. Report of a case.  J Neurosurg Sci. 1983;  27 211-217
• 14 Tomasello F, D'Avella D, Salpietro F M. et al . Asymptomatic aneurysms: Literature meta-analysis and indications for treatment.  J Neurosurg Sci. 1998;  42 47-51
• 15 Jakubowski J, Kendall B. Coincidental aneurysms with tumours of pituitary origin.  J Neurol Neurosurg Psychiatry. 1978;  41 972-979
• 16 Pant B, Arita K, Kurisu K. et al . Incidence of intracranial aneurysm associated with pituitary adenoma.  Neurosurg Rev. 1997;  20 13-17
• 17 Weir B. Pituitary tumors and aneurysms: case report and review of the literature.  Neurosurgery. 1992;  30 585-591
• 18 Mangiardi J R, Aleksic S N, Lifishitz M. et al . Coincidental pituitary adenoma and cerebral aneurysm with pathological findings.  Surg Neurol. 1983;  19 38-41
• 19 Benson P J, Sung J H. Cerebral aneurysms following radiotherapy for medulloblastoma.  J Neurosurg. 1989;  70 545-550
• 20 Jensen F K, Wagner A. Intracranial aneurysm following radiation therapy for medulloblastoma. A case report and review of the literature.  Acta Radiologica. 1997;  38 37-42
• 21 Ho K L. Neoplastic aneurysm and intracranial hemorrhage.  Cancer. 1982;  50 2935-2940
• 22 Roeltgen D P, Weimer G R, Patterson L F. Delayed neurologic complications of left atrial myxoma.  Neurology. 1981;  31 8-13
• 23 Lindert E van, Perneczky A, Fries G. et al . The supraorbital keyhole approach to supratentorial aneurysms: concept and technique.  Surg Neurol. 1998;  49 481-490