Management of associated primary cerebral neoplasms and vascular malformations: 1. Intracranial aneurysms

18 patients harbouring a primary cerebral tumour associated with one or more intracranial aneurysms are presented. Initial symptoms were caused in 10 cases by the tumour, in 8 cases by aneurysmal rupture. In 2 cases the tumour was discovered years after the exclusion of the aneurysm. The tumour was supratentorial in 14 cases, and was more commonly a meningioma (44% of cases) or glioma (38% of cases). A total of 25 aneurysms were observed in the 18 patients: 8 had ruptured and 17 were incidental. The aneurysms were more commonly on the internal carotid artery (40%). Surgical treatment was undertaken in 13 patients, and consisted of: a) tumour resection plus aneurysmal exclusion in 6 patients, b) only tumour resection in 5 patients with incidental aneurysms, and c) only exclusion of the aneurysm in 2 patients later developing malignant gliomas. Rupture of incidental aneurysms was never observed. The prognosis was linked mainly to the nature of the tumour in cases with malignant tumours, and to the evolution of subarachnoid haemorrhage in patients with ruptured aneurysms. As a whole, a satisfactory recovery was observed in 7 patients, and death occurred in 11 patients, mainly due to progressive evolution of the malignant tumour (in 6 cases) or to fatal aneurysmal rebleeding (in 3 cases). It is concluded that tumours associated with aneurysms should be operated on at the same time whenever possible, and decisions regarding exclusion of incidental aneurysms should be balanced against the risks of the procedure.