Preoperative assessment of perforating arteries around amygdala glioblastoma using intra-arterial CT angiography with ultra-high-resolution CT and MR tractography: a case report

Preservation of the perforating arteries (PAs) supplying the pyramidal tract (PT-PAs) is essential during glioblastoma resection. A 60-year-old man presented with sensory aphasia caused by a left medial temporal glioblastoma. To determine the surgical indication and strategy, we assessed the tumor's location and its relationship with the PT-PAs using intra-arterial computed tomography (CT) angiography combined with ultra-high-resolution CT (UHR-IA-CTA), gadolinium-enhanced T1-weighted magnetic resonance imaging, and tractography. Imaging revealed an amygdala glioblastoma without the involvement of PT-PAs. Total tumor resection was achieved without neurological deficits. This case highlights how integrating UHR-IA-CTA can guide surgical planning and enable safe, complete glioblastoma resection.