Glioblastoma with pseudo-arteriovenous malformation features: Combined arterial spin-labeling assessment and preoperative embolization.

BACKGROUND

Glioblastoma (GBM) may occasionally present with prominent vascular features that mimic an arteriovenous malformation (AVM), leading to diagnostic and therapeutic challenges. Pseudo-AVM GBMs are rare, and their recognition is essential to avoid misdiagnosis and inappropriate management.

CASE DESCRIPTION: We report a 67-year-old male with a 2-month history of progressive headache, memory impairment, and speech difficulties. Neurological examination demonstrated mild right-sided limb weakness, homonymous hemianopsia, and expressive aphasia. Brain magnetic resonance imaging (MRI), computed tomography angiography, and digital subtraction angiography revealed a left temporal GBM with AVM-like vascular features. Arterial spin labeling (ASL) perfusion MRI revealed marked hyperperfusion and early venous drainage, providing noninvasive confirmation of tumor-related shunting. To reduce intraoperative bleeding risk, partial preoperative embolization of feeding arteries from the middle cerebral artery was performed, followed by gross total microsurgical resection. Histopathological examination demonstrated a hypervascular GBM, isocitrate dehydrogenase (IDH)-wildtype, with microvascular proliferation and necrosis confirmed by immunohistochemistry and polymerase chain reaction. Postoperative recovery was uneventful, and adjuvant chemoradiation according to the Stupp protocol was recommended.

CONCLUSION

This case highlights pseudo-AVM GBM as a diagnostic and therapeutic challenge and demonstrates the value of ASL perfusion MRI and presurgical embolization in selected hypervascular tumors.