Case report: A Rare Case Involving the Coexistence of Glioblastoma Multiforme, Arteriovenous Malformation and Intracranial Aneurysm

BackgroundThe coexistence of Glioblastoma Multiforme (GBM) and Arteriovenous Malformation (AVM) is rarely reported in literature. Additionally, there is a paucity of data surrounding the simultaneous presentation of Glioblastoma Multiforme (GBM) with intracranial aneurysms. In the English literature, the concurrence of these three intracranial lesions has never been reported. Regarding our case, we present a case of an Internal Carotid Artery (ICA) aneurysm that occurred in a patient with coexisting GBM and AVM. In addition, we discuss the current literature relating to this unique combination of medical conditions.Case PresentationThe 44-year-old female was presented to our hospital experiencing intermittent headaches and dizziness. Magnetic Resonance Imaging (MRI) revealed a heterogeneously enhanced mass with peri-focal edema at the right temporal lobe. Upon additional computed tomographic angiography study, the presence of AVM nidus at the right temporal-parietal occipital region was noted. Moreover, the image study also demonstrated a right ICA aneurysm. After surgery, histopathological examination demonstrated GBM and AVM in the separately resected lesion specimen. Furthermore, we expected that the ICA aneurysm would reduce in size after removal of the ipsilateral AVM and glioblastoma. Unfortunately, the postoperative digital subtraction angiography revealed only sparse change in the right ICA aneurysm, resulting in the patient still needing to receive intervention involving flow diverter stent placement.ConclusionsIn this case, we discuss the current literature relating to this unique combination of medical conditions. The causality and correlation of this presentation remains uncertain. With regards to our case, the pre-surgical image survey provided us with much support towards making critical decisions. Surgery surrounding the removal of simultaneously coexisting AVM and GBM is always a challenging task due to the potential risk of massive intraoperative bleeding.