title: Flow-Related Aneurysm within Glioblastoma: A Case Report and Review of Literature.
abstract: BACKGROUND
  Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults, with a median survival of 13 months despite surgery and chemoradiation. GBMs are often hypervascular tumors caused by abnormal oversecretion of growth factors such as vascular endothelial growth factor. These angiogenic factors are hypothesized to promote increased blood flow and possibly secondary changes to arterial walls, thus facilitating the formation of flow-related aneurysms.
  
  
  METHODS
  A 59-year-old woman presented with headaches, confusion, nausea and emesis. Computed tomography and magnetic resonance imaging revealed a hypervascular lesion, likely high-grade glioma, in the right frontal lobe, with a dilated vessel within the tumor. Cerebral angiography demonstrated a flow-related aneurysm on the right frontopolar artery supplying the tumor. The aneurysm was embolized with coils and the patient later underwent craniotomy for near total resection of the lesion without complications. Final pathology returned GBM with dilated vessels noted.
  
  
  CONCLUSIONS
  Hypervascular lesions, such as GBMs, may be associated with flow-related aneurysms on feeding arteries, but aneurysms within the gross tumor are unusual. Although rare, this finding needs to be recognized on preoperative imaging before tumor resection to prevent potentially catastrophic intraoperative complications.
authors: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA. Electronic address: chiba@uw.edu.
authors: Chibawanye I
authors: CI
authors: Ene
authors: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
authors: John D
authors: JD
authors: Nerva
authors: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
authors: Lynn
authors: L
authors: McGrath
authors: Department of Pathology, University of Washington, Seattle, Washington, USA.
authors: Margaret E
authors: ME
authors: Flanagan
authors: Department of Neurology, University of Washington, Seattle, Washington, USA.
authors: Marc C
authors: MC
authors: Chamberlain
authors: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
authors: Daniel L
authors: DL
authors: Silbergeld
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology*; D015901:Angiography, Digital Subtraction; D001932:Brain Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D003399:Craniotomy; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
chemical_list: D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53
keywords: Aneurysm; Angiography; Embolization; Glioblastoma; Glioma