Article
Coexistence of intracranial aneurysms and neoplasms – a surgical challenge
Die Koexistenz von intrakraniellen Aneurysmen und Neoplasien – eine chirurgische Herausforderung
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Authors
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B. Fischer
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
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S. Palkovic
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
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L. Lemcke
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
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H. Wassmann
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
| Published: | May 8, 2006 |
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Outline
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Objective: Coexistence of intracranial aneurysms and neoplasms can be found in up to 1% within the population. In the most cases tumor entity is a meningioma, glioma or tumor of sellar region. In 1972 Pia et al. reviewed 24000 patients suffering from intracranial tumors. In the group of patients with both pathologies they found a perioperative mortality of about 38%. Until now no safe treatment strategy is known. We reviewed the literature and report on our experience with patients suffering from coexistent cerebral aneurysm and neoplasia.
Methods: We searched the literature with the following keywords:”tumor, aneurysm” and “coincidence” or “co-existence” in the different combinations and spelling. In the same way we searched in our own patients data base. The data of published cases and our own patients were analyzed in regard to tumor entity and localisation, aneurysm origin, cause of symptoms (aneurysm and/or tumor), treatment strategy, outcome and follow up.
Results: Reviewing the literature we found 226 patients with documented coexistence of tumor and aneurysm. In most cases aneurysm occur with meningiomas (91), followed by pituitary gland tumors (61), gliomas (27) and metastatic neoplasms (12). Other brain tumor entities occur very rare. Clinical symptoms occurred in 82% due to the tumor, in only 12% by aneurysm rupture or size and in 6% the cause of the symptoms were not clear. In 9 patients coexistence of tumor and aneurysm was found post mortem. Perioperative death was documented in 50 patients (22.1%). In our collected data we found 10 patients with aneurysm and meningioma and 1 patient with aneurysm and astrocytoma. In 11 published and one of our patients the aneurysm was found within the tumor. In all our patients tumors were removed by surgery, in three patients in combination with coiling of aneurysm.
Conclusions: Coexistence of intracranial aneurysms and neoplasms is found very seldom. The special case of an intratumoral aneurysm was found in only 12 published cases. For a safe and successful treatment, the aneurysm should be treated at first, even if it is adjacent to or within the tumor, latter should be resected secondary. An appropriate neuroimaging is necessary for decision which kind of treatment modality should be chosen.
