Brain angiometastasis from a non-seminomatous germ cell tumor: A case report

INTRODUCTION: Brain metastasis from non-seminomatous germ cell tumors (NSGCT) is rare. Herein, we describe the second reported case of brain metastasis from a NSGCT with high-flow arteriovenous (AV) shunts, and propose a novel surgical treatment plan. CLINICAL CASE: The patient was a 34-year-old male who presented with hemiparesis and hemianesthesia. Magnetic resonance angiography revealed three vascular lesions with afferent vessels and efferent vessels. Angiography displayed two high-flow AV shunts. During angiography, the patient experienced sudden neurological deterioration and consequently underwent surgery. During surgery, a lesion with large AV shunts was observed, with arterialized drainage veins, pedicled arterial vessels affluent to the nidus, and an absent pial plane. The surgical technique was adapted to lesion morphology using special bipolar forceps. Histological and immunohistochemical tests confirmed that the lesion was a NSGCT. DISCUSSION: NSGCTs are clinically more aggressive than seminomas. Lesions with an AV shunt and glioma combination are designated as angiogliomas. Therefore, we termed the lesion in the present case as an “angiometastasis,” which was formed from numerous AV shunts. The use of presurgical embolization has been reported to improve long-term survival in patients with intra-axial hypervascular tumors with AV shunts. CONCLUSION: We here propose a novel strategy for the management of hypervascular brain metastasis from NSGC, consisting of angiography, tumor embolization, and the use of an angiometastatic surgical technique with special bipolar forceps. This case report may help neurosurgeons make better surgical decisions in the management of highly vascularized brain metastasis.