Asymptomatic intracranial abnormalities are increasingly becoming a focus of attention with the utilization of high-resolution imaging. The concurrence of tumor and aneurysm has been described, largely, by case reports and single-surgeon experiences. Recent papers have outlined the ethics of incidental findings and possible treatment algorithms. Incidental finding of an aneurysm occurs most commonly in patients with meningiomas, pituitary adenomas, and gliomas. Such an association may explain the mechanisms of aneurysm formation, growth, and rupture in acromegalic patients; however, insufficient data are available to link aneurysm with either glioma or meningioma. 1. Introduction The radiographic characterization of a primary lesion may present a new clinical issue when a second asymptomatic intracranial lesion is identified. This issue is expected to become increasingly more frequent as the resolution of neuroimaging progresses [1, 2]. The ethics and clinical approach algorithm is currently under discussion [3]; however, the relationship between two concurrent intracranial lesions is not completely understood. The existence of a single lesion has been hypothesized to initiate additional lesions in the brain [4]. The occurrence of tumor together with aneurysm has been noted in case reports and series, but a comparison between tumor types and aneurysm location has been rarely studied. Our focus is to document the concurrence of aneurysm and tumor across the literature and to describe the treatment outcomes, including observation. We hope to achieve a new understanding of the possible associations of meningiomas, pituitary adenomas, and gliomas with aneurysm formation, growth, and rupture. 2. Methods 2.1. Literature Review Articles were identified from a systematic literature review using PubMed and MEDLINE databases for the years 1950 through 2012 with the following search terms: “cerebral aneurysm,” “intracranial aneurysm,” “brain tumor,” “meningioma,” “glioma,” “glioblastoma multiforme,” “pituitary adenoma,” “ruptured,” “unruptured,” and/or “subarachnoid hemorrhage.” Additional publications were located and reviewed based on the references in the articles obtained from the database searches. Inclusion criteria required that appropriate articles be published as full-length articles in a peer-reviewed, English language journal. Studies were excluded if the co-occurrence of tumor and aneurysm could be separated. For example, aneurysms were excluded which appeared to develop within a postoperative area or that were labeled as pseudoaneurysms. If multiple
References
[1]
G. L. Katzman, A. P. Dagher, and N. J. Patronas, “Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers,” Journal of the American Medical Association, vol. 282, no. 1, pp. 36–39, 1999.
[2]
M. W. Vernooij, M. A. Ikram, H. L. Tanghe et al., “Incidental findings on brain MRI in the general population,” New England Journal of Medicine, vol. 357, no. 18, pp. 1821–1828, 2007.
[3]
D. Drazin, K. Spitler, M. Cekic, et al., “Incidental finding of tumor while investigating subarachnoid hemorrhage: ethical considerations and practical strategies,” Science and Engineering Ethics, 2012.
[4]
H. W. Pia, S. Obrador, and J. G. Martin, “Association of brain tumours and arterial intracranial aneurysms,” Acta Neurochirurgica, vol. 27, no. 3-4, pp. 189–204, 1972.
[5]
T. A. Dolecek, J. M. Propp, N. E. Stroup, and C. Kruchko, “CBTRUS Statistical Report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009,” Neuro-Oncology, vol. 14, pp. v1–v49, 2012.
[6]
R. Manara, P. Maffei, V. Citton et al., “Increased rate of intracranial saccular aneurysms in acromegaly: an MR angiography study and review of the literature,” Journal of Clinical Endocrinology and Metabolism, vol. 96, no. 5, pp. 1292–1300, 2011.
[7]
B. R. Fischer, S. Palkovic, M. Holling, T. Niederstadt, A. Jeibmann, and H. Wassmann, “Coexistence of cerebral aneurysm and meningioma-pure accident?” Clinical Neurology and Neurosurgery, vol. 111, no. 8, pp. 647–654, 2009.
[8]
S. Larjavaara, H. Haapasalo, R. Sankila, P. Helén, and A. Auvinen, “Is the incidence of meningiomas underestimated? A regional survey,” British Journal of Cancer, vol. 99, no. 1, pp. 182–184, 2008.
[9]
A. Ishibashi, T. Shirouzu, H. Nakashima, M. Watanabe, and S. Kuramoto, “Coincidence of a brain tumor and a cerebral arterial aneurysm–report of a case and review of the literature,” Kurume Medical Journal, vol. 31, no. 3, pp. 229–233, 1984.
[10]
V. Javalkar, B. Guthikonda, P. Vannemreddy, and A. Nanda, “Association of meningioma and intracranial aneurysm: report of five cases and review of literature,” Neurology India, vol. 57, no. 6, pp. 772–776, 2009.
[11]
M. H. M. Vlak, A. Algra, R. Brandenburg, and G. J. E. Rinkel, “Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis,” The Lancet Neurology, vol. 10, no. 7, pp. 626–636, 2011.
[12]
J. Jakubowski and B. Kendall, “Coincidental aneurysms with tumours of pituitary origin,” Journal of Neurology Neurosurgery and Psychiatry, vol. 41, no. 11, pp. 972–979, 1978.
[13]
B. Pant, K. Arita, K. Kurisu, A. Tominaga, K. Eguchi, and T. Uozumi, “Incidence of intracranial aneurysm associated with pituitary adenoma,” Neurosurgical Review, vol. 20, no. 1, pp. 13–17, 1997.
[14]
C. Licata, A. Pasqualin, and A. Freschini, “Management of associated primary cerebral neoplasms and vascular malformations. I. Intracranial aneurysms,” Acta Neurochirurgica, vol. 82, no. 1-2, pp. 28–38, 1986.
[15]
P. E. Taylor, “Delayed postoperative hemorrhage from intracranial aneurysm after craniotomy for tumor,” Neurology, vol. 11, pp. 225–231, 1961.
[16]
H. Yamada and K. Taomoto, “Postoperative subrachnoid hemorrhage from an intracranial aneurysm after craniotomy for astrocytoma—case report,” Neurologia Medico-Chirurgica, vol. 29, no. 9, pp. 846–849, 1989.
[17]
W. Y. Cheng and C.-C. Shen, “Minimally invasive approaches to treat simultaneous occurrence of glioblastoma multiforme and intracranial aneurysm—case report,” Minimally Invasive Neurosurgery, vol. 47, no. 3, pp. 181–185, 2004.
[18]
A. Hashiguchi, M. Morioka, H. Ichimura, C. Mimata, and J.-I. Kuratsu, “Glioblastoma with an intratumoral feeding-artery aneurysm,” Clinical Neurology and Neurosurgery, vol. 109, no. 3, pp. 302–304, 2007.
[19]
H. Turan Suslu and M. Bozbuga, “Primary brain tumors associated with cerebral aneurysm: report of tree cases,” Turkish Neurosurgery, vol. 21, no. 2, pp. 216–221, 2011.
[20]
H. Z. Gokalp, N. Avman, E. Ozkal, and B. Gokben, “Brain tumour associated with intracranial arterial aneurysm,” Acta Neurochirurgica, vol. 53, no. 3-4, pp. 267–273, 1980.
[21]
A. S. Jakola, K. S. Myrmel, R. Kloster, et al., “Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas,” Journal of the American Medical Association, vol. 308, pp. 1881–1888, 2012.
[22]
J. Pallud, D. Fontaine, H. Duffau et al., “Natural history of incidental world health organization grade II gliomas,” Annals of Neurology, vol. 68, no. 5, pp. 727–733, 2010.
[23]
H.-J. Steiger, “Preventive neurosurgery: population-wide check-up examinations and correction of asymptomatic pathologies of the nervous system,” Acta Neurochirurgica, vol. 148, no. 10, pp. 1075–1083, 2006.
[24]
J. Illes, M. P. Kirschen, E. Edwards et al., “Incidental findings in brain imaging research,” Science, vol. 311, no. 5762, pp. 783–784, 2006.
[25]
C. A. Nelson, “Incidental findings in magnetic resonance imaging (MRI) brain research,” Journal of Law, Medicine and Ethics, vol. 36, no. 2, pp. 315–319, 2008.
[26]
G. Hartwigsen, H. R. Siebner, G. Deuschl, O. Jansen, and S. Ulmer, “Incidental findings are frequent in young healthy individuals undergoing magnetic resonance imaging in brain research imaging studies: a prospective single-center study,” Journal of Computer Assisted Tomography, vol. 34, no. 4, pp. 596–600, 2010.
[27]
J. Handa, I. Matsuda, and H. Handa, “Association of brain tumor and intracranial aneurysms,” Surgical Neurology, vol. 6, no. 1, pp. 25–29, 1976.
[28]
T. Okamura, Y. Watanabe, H. Kameda, H. Aoki, and K. Kurokawa, “Coexistence of brain tumors and cerebral aneurysms. Clinical considerations from eight cases,” Neurologia Medico-Chirurgica, vol. 21, no. 6, pp. 601–608, 1981.
[29]
B. V. Nahed, M. L. DiLuna, T. Morgan et al., “Hypertension, age, and location predict rupture of small intracranial aneurysms,” Neurosurgery, vol. 57, no. 4, pp. 676–683, 2005.
