Background: Angiocentric glioma (AG) is an extremely rare intracranial tumor that was first described in 2005 and identified as a special type of intracranial tumor in 2007 by the WHO, which mainly affects children and young adolescents. Epilepsy is the main presentation; therefore, it was recognized as a seizure-related tumor in the past. Here, we report a case of AG with acute intracerebral hemorrhage (ICH) as the first symptom who never had a seizure onset. Case Description: A 3-year-old girl with the right limb weakness was admitted to our hospital 4 h after onset in 2018. Computed tomography showed a hematoma of about 20 ml accompanied by a hyper/iso-dense spheroid lesion located in the sub-cortex of the left parietal lobe. Magnetic resonance image (MRI) showed signs of hypointense signal in T1, T2, and fluid-attenuated inversion recovery sequence, distinct enhancement of this tumefactive lesion in the contrast-enhanced sequence. Thus, the admission diagnosis was neoplasm with acute ICH. A gross total resection of the tumor was achieved by parietal craniotomy. The histopathological diagnosis was AG. No signs showed tumor recurrence after 36 months of follow-up. Conclusion: This is the sole case of AGs with acute intracranial hemorrhage as the first symptom without any kind of epilepsy by far. This case had unique MRI signs that were different from the previous description. This case enriches the clinical and radiological manifestations of AG and reveals that further investigations are needed to further understand AG.

Background In recent years, smaller-sized (diameter < 2.5 cm) meningiomas are diagnosed due to increased cranial imaging. Symptomatic meningiomas need to be removed surgically. Therefore, it is extremely important to locate the lesion exactly to tailor the craniotomy especially if the neuro-navigation system is not available. Many hospitals located in the underdeveloped countries cannot afford the high costs of neuro-navigation equipment. Hence, it is relevant to discover low-cost associated and effective methods for lesion localization for surgery. Methods The use of localization markers in advance can help to acquire preoperative CT images of the patients to create and calculate a three-dimensional (3D) virtual graph using a computer. With the 3D graph, spatial distance of the tumor from the markers is calculated and the tumor location projected on the scalp by the Triangle Pythagorean theorem. This enables precise localization of intracranial microlesions preoperatively. Results The location of the tumor was consistent with that of the pre-operative virtual image, and the craniotomy was exact. The patient was discharged 3 days later without any neurological deficits. Conclusions This method is simple and reliable, inexpensive, and accurate in the location of small-sized lesions, which can partially compensate for the lack of neuro-navigation and is suitable for widespread application in hospitals in developing countries.