title: Rare presentation of intracranial vascular blowout after tumor resection and radiation therapy.
abstract: A middle-aged patient presented with a rapidly growing right dural-based extra-axial posterior clinoid mass extending to the right cavernous sinus that was surgically resected. Histological examination showed solid growth of primitive neuroectodermal tumor arising from the third nerve. Following surgical resection, the patient was further managed by radiation and chemotherapy. Two years later the patient developed new intracranial hemorrhage in the area adjacent to the previous surgical cavity. A cerebral angiogram showed contrast extravasation at the junction of the posterior communicating artery (Pcom) and the right posterior cerebral artery (PCA), with an expanding pseudoaneurysm. This was managed with N-butyl cyanoacrylate embolization. Autopsy showed microscopic recurrence of tumor into the PCA/PCom region with invasion of the wall of the Pcom. This case report illustrates the concept of vascular blowout in intracranial cerebral vasculature. It appears that, in the presence of risk factors that contribute to weakening of vessel walls (surgery, radiation, tumor recurrence), a blowout can occur intracranially.
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
authors.forename: Mandana
authors.initials: M
authors.lastname: Behbahani
authors.forename: Tibor
authors.initials: T
authors.lastname: Valyi-Nagy
authors.forename: Nathan
authors.initials: N
authors.lastname: Aardsma
authors.forename: Victor A
authors.initials: VA
authors.lastname: Aletich
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003390:Cranial Nerve Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008875:Middle Aged; D018242:Neuroectodermal Tumors, Primitive / Q000532:radiotherapy* / Q000601:surgery*; D009802:Oculomotor Nerve; D020769:Posterior Cerebral Artery / Q000473:pathology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012422:Rupture, Spontaneous / Q000209:etiology; D013577:Syndrome
keywords: Angiography; Hemorrhage; Liquid Embolic Material; Malignant; Neoplasm
references.citation: Surg Neurol. 1993 Jul;40(1):61-4
references.pmid: 8322183
references.citation: AJNR Am J Neuroradiol. 2005 Mar;26(3):666-9
references.pmid: 15760885
references.citation: Surg Neurol Int. 2011;2:67
references.pmid: 21697983
references.citation: J Vasc Surg. 1999 Dec;30(6):1045-51
references.pmid: 10587388
references.citation: J Vasc Surg. 2008 May;47(5):936-45
references.pmid: 18328665
references.citation: Laryngoscope. 1981 May;91(5):677-700
references.pmid: 7231019
references.citation: Otolaryngol Head Neck Surg. 1983 Jun;91(3):308-12
references.pmid: 6410336
references.citation: Neurosurgery. 2001 Jul;49(1):200-2; discussion 202-3
references.pmid: 11440443
references.citation: Oncol Nurs Forum. 1983 Winter;10(1):14-8
references.pmid: 6553307
references.citation: Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):1083-9
references.pmid: 21549520
references.citation: Laryngoscope. 2002 Mar;112(3):428-33
references.pmid: 12148848
references.citation: Arch Otolaryngol. 1974 Apr;99(4):235-41
references.pmid: 4131800
references.citation: World Neurosurg. 2012 Jul;78(1-2):109-14
references.pmid: 22120297
references.citation: Oral Oncol. 2004 Oct;40(9):872-8
references.pmid: 15380164