Early cerebral venous drainage associated with a brain tumor: a correlation of digital subtraction angiography and MRI. Illustrative case

BACKGROUND: Early venous drainage (EVD) is a critical diagnostic feature of arteriovenous malformations (AVMs). However, other conditions can be associated with EVD and mimic AVMs. OBSERVATIONS: This is a unique case of a 19-year-old female who presented with seizures secondary to a hemorrhagic intra-axial mass and subdural hematoma. MRI demonstrated heterogeneous enhancement and extensive perilesional FLAIR changes. Cerebral angiography was consistent with a left parietal vascular lesion, with EVD consistent with arteriovenous shunting and increased blood flow. Subsequently, the patient underwent urgent left-sided craniotomy with gross-total resection. Intraoperative findings confirmed a highly vascular tumor with numerous small tortuous vessels. Histopathological analysis revealed a grade 3 anaplastic pleomorphic xanthoastrocytoma. LESSONS: EVD observed during catheter angiography usually indicates the presence of an AVM. However, EVD can also be seen with gliomas, often indicating a higher grade. Additionally, catheter angiography could prove useful as an indicator of tumor margins and therefore may be helpful when planning the overall extent of resection. Further oncological validation is needed. https://thejns.org/doi/10.3171/CASE2679.