Contemporaneous Clipping of Unruptured Anterior Cerebral Artery Proximal A1 Segment Aneurysm and Resection of Dural-Based Brain Tumor

The coexistence of brain tumors and unruptured intracranial aneurysms is uncommon, so there is limited data regarding management strategies for these cases. Tumor, aneurysm, and patient factors must be considered in the decision-making process. We present a case of a dural-based left temporal brain tumor with an incidental ipsilateral unruptured anterior cerebral artery (ACA) proximal A1 segment aneurysm. A 56-year-old female presented with progressive headaches and convulsions without focal neurological deficits. Neuroimaging showed a large dural-based left temporal tumor with adjacent vasogenic edema. The patient underwent a cerebral angiography for preoperative tumor embolization, which revealed a small, unruptured intracranial aneurysm arising from the left ACA proximal A1 segment. We performed a left frontotemporal craniotomy for concurrent resection of the dural-based tumor and clipping of the left A1 aneurysm. She elected to proceed, so she underwent a left-sided craniotomy for tumor resection and clipping of the aneurysm. Postoperatively, the patient developed transient, mild right-sided hemiparesis from a left anterior thalamic infarct that resolved before discharge. Follow-up brain magnetic resonance imaging and catheter cerebral angiography showed gross total resection of the tumor and complete aneurysm obliteration, respectively. Patients with dual diagnoses of a brain tumor and intracranial aneurysm can be challenging to manage. When intervention is indicated for each lesion and both can be safely accessed from the same operative approach, contemporaneous surgical treatment of the tumor and aneurysm is reasonable in appropriately selected cases.