Hypervascular acoustic neuroma

The authors present a patient with a large acoustic neuroma that exhibited an unusual vascular architecture. Magnetic resonance imaging demonstrated m ultiple flow voids in and around the mass. At surgery, intra- and extratumo ral vascularity was arterialized due to luxurious shunting. Two attempts at removal produced severe engorgement and pulsatility of the surrounding bra in, dramatically narrowing the operative exposure. Piecemeal resection of t he tumor seemed to redistribute blood flow resulting in engorgement of the surrounding brain, analogous to perfusion breakthrough following AVM resect ion. Treatment strategies similar to those used for AVM resection may be in dicated when encountering a hypervascular tumor.