Glioblastoma and intracranial aneurysms: Case report and review of literature

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.

Keywords: Glioblastoma multiforme; intracranial aneurysm; pseudoaneurysm; subarachnoid hemorrhage.

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