Arteriovenous Malformation with Underlying Radiologically Silent Primary Brain Tumor: Case Report and Literature Review

Background: The coexistence of clearly demarcated glioma and vascular malformation is rarely identified. Astrocytomas represent the most common subtype found. Methods: We conducted a systematic review of the literature published until December 2019, using the PubMed database, recording all histologically documented cases of AVM associated with primary brain tumor. We have reported for each case, study date, age, sex, intracranial site of the lesion, histopathological features, the neuroradiological techniques used for diagnosis, extension of surgical resection (biopsy, partial, total), adjuvant treatment (radiotherapy, chemotherapy, trans-arterial embolization) and overall survival. Results: With our case, only 21 cases of angiographically detected arteriovenous malformation and histologically proven primary brain tumor, have been documented. The mean age was 42 years (range 8-72) with male prevalence (12 M, 9 F). Total tumor resection was obtained in 12 cases (57.1%), a partial resection in 4 cases (19.04%) whereas a biopsy was performed in 2 cases (9,5%); in 2 cases no information about the extent of resection was reported whereas in one 1 case no tissue sampling was obtained because of the death of the patient. AVM was treated with XRT in 5 cases (23.8%), subtotal resection (STR) was performed in 2 cases (9.5%), trans-catheter embolization was performed in 2 cases (9.5%) and in 1 case no treatment was performed for the patient’s death. Conclusion: The association between primary brain tumors and arteriovenous malformation is a rare entity that presents various pathogenic hypotheses and diagnosis can be difficult. In all these cases, we recommend a detailed histological examination of the parenchyma adjacent to the AVM.