Successful Preoperative Endovascular Embolization of an Extreme Hypervascular Glioblastoma Mimicking an Arteriovenous Malformation.

Abstract

Preoperative endovascular embolization as a treatment for hypervascular glioblastomas has not been established. We report the case of an extreme hypervascular glioblastoma mimicking an arteriovenous malformation that was successfully treated with preoperative embolization and subsequent removal. A 66-year-old man presented with progressive right hemiparesis and sensory aphasia. Cranial computed tomography and magnetic resonance imaging revealed a left parietooccipital tumor with ring enhancement. Digital subtraction angiography revealed an extreme high-flow arteriovenous shunt. The patient underwent presurgical endovascular embolization using N-butyl cyanoacrylate in a manner similar to embolization for arteriovenous malformations. Subsequent tumor removal was achieved with minimal blood loss. This is the first reported case of presurgical embolization of a glioblastoma with a high-flow shunt. Embolization of a malignant tumor with a high-flow shunt, in a manner similar to embolization of arteriovenous malformations, is feasible and effective.