Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

Abstract

ObjectiveFew studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery.Materials and MethodsA total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated.ResultsSingle-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2–120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0–2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery.ConclusionPreoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.

Enlargement of an incidental internal carotid artery aneurysm embedded in pituitary adenoma associated with medical shrinkage of the tumor: Case report

“…[ 11 20 34 35 ] To our knowledge, there are only two reported cases of ICA aneurysms embedded within a pituitary adenoma. [ 6 26 ] On the other hand, intraoperative iatrogenic injury to the ICA is a known and much feared complication with a rate of as high as 1.1%. [ 2 8 9 ] However, there is only one case report of an iatrogenic rupture of an aneurysm embedded within the pituitary adenoma.…”

“…Thus, there is some concern that an incidental aneurysm may be present within the sellar region and become the cause for catastrophic intraoperative complications. [ 26 ]…”

Surgery for Triple Pathology of Giant Vestibular Schwannoma Associated with Carotid Artery Stenosis and Intracranial Aneurysm: Case Report

“… 12 Similarly, craniotomy and intracranial pressure change can increase the risk of aneurysm rupture. 8 9 10 11 For these reasons, the vascular pathology should be initially considered. However, whether the stenosis or the aneurysm should be treated first surgically remains unclear.…”

“…The prevalence of concomitant cerebral aneurysm and brain tumor is 0.3 to 7.7%. 8 9 Aneurysms are most commonly found in combination with meningioma, pituitary adenoma, and glial tumors, although there have been case reports of a combination with VS. 10 11 A combination of ICA extracranial stenosis and brain tumor is rare and has been described in the literature only as single cases. 12 …”

Contemporaneous Clipping of Unruptured Anterior Cerebral Artery Proximal A1 Segment Aneurysm and Resection of Dural-Based Brain Tumor

“…The association between brain tumors and intracranial aneurysms has been previously described, with significant variability in the reported coincidence rate. The majority of aneurysms in published reports involved the paraclinoid internal carotid artery (ICA), anterior communicating artery, and middle cerebral artery, and the majority of associated tumors were meningiomas, pituitary adenomas, and gliomas [1][2][3][4][5][6]. The exact relationship between intracranial neoplasms and aneurysms is unknown, but several mechanisms have been hypothesized, including increased regional blood flow, presence of dysgenetic factors, and tumor-induced injury of the arterial wall [2,4,6].…”