Teshigawara Akihiko, Kyoichi Tomoto, Hasegawa Yuzuru, Murayama Yuichi, Tanaka Toshihide
Neurosurgery, The Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, JPN.
Neurosurgery, The Jikei University School of Medicine, Tokyo, JPN.
Cureus. 2024 Sep 20;16(9):e69794. doi: 10.7759/cureus.69794. eCollection 2024 Sep.
Given that glioblastoma (GBM), meningioma (Mg), and dural arteriovenous fistula (dAVF) represent angiogenic diseases mainly caused by vascular endothelial growth factor (VEGF), bevacizumab (Bev) is expected to be effective against these diseases. We report a patient with concomitant GBM, Mg, and dAVF who was treated with neoadjuvant Bev, resulting in a reduction in the volume of GBM along with an improvement of clinical symptoms. An 85-year-old male presented with aphasia, gait disturbance, and dementia. Magnetic resonance imaging (MRI) showed a ring-enhanced intra-axial tumor with perifocal edema in the left temporal lobe, a dura-attached extra-axial tumor at the left sphenoid ridge, and dAVF at the left transverse-sigmoid sinus. Due to the age of the patient and low Karnofsky Performance Status (KPS) score, pharmacotherapy with a single dose of Bev was chosen over surgical resection. Three days after the Bev administration, aphasia and gait disturbance had dramatically improved. Volume reduction rates at one and five months after three administrations of Bev were 0.34% and 95.9% for GBM and 13.7% and 6.8% for meningioma, respectively. No significant change in dAVF was seen on digital subtraction angiography (DSA) during Bev therapy. VEGF concentration in GBM is known to be the highest among all types of brain tumors, including meningioma. VEGF might not play a pivotal role in the pathogenesis of dAVF. Based on this evidence from the present rare case with concomitant GBM, meningioma, and dAVF, responsiveness to Bev might depend on the level of VEGF expression.
鉴于胶质母细胞瘤（GBM）、脑膜瘤（Mg）和硬脑膜动静脉瘘（dAVF）是主要由血管内皮生长因子（VEGF）引起的血管生成性疾病，贝伐单抗（Bev）有望对这些疾病有效。我们报告了一名同时患有GBM、Mg和dAVF的患者，该患者接受了新辅助Bev治疗，导致GBM体积减小，临床症状改善。一名85岁男性出现失语、步态障碍和痴呆。磁共振成像（MRI）显示左颞叶有一个环形强化的轴内肿瘤伴灶周水肿，左蝶骨嵴有一个硬膜附着的轴外肿瘤，左横窦-乙状窦交界处有dAVF。由于患者年龄较大且卡氏功能状态（KPS）评分较低，选择单剂量Bev药物治疗而非手术切除。给予Bev三天后，失语和步态障碍显著改善。三次给予Bev后1个月和5个月时，GBM的体积缩小率分别为0.34%和95.9%，脑膜瘤的体积缩小率分别为13.7%和6.8%。在Bev治疗期间，数字减影血管造影（DSA）显示dAVF无明显变化。已知在所有类型的脑肿瘤中，包括脑膜瘤，GBM中的VEGF浓度最高。VEGF可能在dAVF的发病机制中不发挥关键作用。基于这例罕见的同时患有GBM、脑膜瘤和dAVF的病例所提供的证据，对Bev的反应性可能取决于VEGF的表达水平。
