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Vascular steal and associated intratumoral aneurysms in highly vascular brain tumors: illustrative case.

Authors :
Hong CS
Marianayagam NJ
Morales-Valero SF
Barak T
Tabor JK
O'Brien J
Huttner A
Baehring J
Gunel M
Erson-Omay EZ
Fulbright RK
Matouk CC
Moliterno J
Source :
Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2023 Mar 06; Vol. 5 (10). Date of Electronic Publication: 2023 Mar 06 (Print Publication: 2023).
Publication Year :
2023

Abstract

Background: Intratumoral aneurysms in highly vascular brain tumors can complicate resection depending on their location and feasibility of proximal control. Seemingly unrelated neurological symptoms may be from vascular steal that can help alert the need for additional vascular imaging and augmenting surgical strategies.<br />Observations: A 29-year-old female presented with headaches and unilateral blurred vision, secondary to a large right frontal dural-based lesion with hypointense signal thought to represent calcifications. Given these latter findings and clinical suspicion for a vascular steal phenomenon to explain the blurred vision, computed tomography angiography was obtained, revealing a 4 × 2-mm intratumoral aneurysm. Diagnostic cerebral angiography confirmed this along with vascular steal by the tumor from the right ophthalmic artery. The patient underwent endovascular embolization of the intratumoral aneurysm, followed by open tumor resection in the same setting without complication, minimal blood loss, and improvement in her vision.<br />Lessons: Understanding the blood supply of any tumor, but highly vascular ones in particular, and the relationship with normal vasculature is undeniably important in avoiding potentially dangerous situations and optimizing maximal safe resection. Recognition of highly vascular tumors should prompt thorough understanding of the vascular supply and relationship of intracranial vasculature with consideration of endovascular adjuncts when appropriate.

Details

Language :
English
ISSN :
2694-1902
Volume :
5
Issue :
10
Database :
MEDLINE
Journal :
Journal of neurosurgery. Case lessons
Publication Type :
Academic Journal
Accession number :
36880509
Full Text :
https://doi.org/10.3171/CASE22512