Minimally invasive resection of intracerebral amyloidoma; case report and systematic review of the literature.

Management of cerebral amyloidomas has lacked consensus due to their rarity. We present the case of a 56 year-old female who presented with a history of intractable headaches and progressive speech difficulty. Imaging demonstrated a 1.7 x 2.6 centimeter (cm) left frontal subcortical hemorrhagic mass with an associated developmental venous anomaly (DVA), characteristics initially suggestive of a cavernous malformation. Diffusion tractography imaging was employed to avoid interference with the intact arcuate fasciculus and corticospinal tracts to minimize neurologic deficits. To the authors' knowledge, this is the first documented case of the utilization of diffusion tractography in the preoperative planning for cerebral amyloidoma resection. Systematic review was performed and 39 reported cases of amyloidomas in the literature were reviewed for their initial presentation, imaging characteristics, treatment, and progression. This provided insight regarding how these rare lesions have presented and progressed, and to further understand current theory regarding their etiology and pathophysiology. The authors concluded that cerebral amyloidomas are rare, localized, proteinaceous aggregates with variable presentation and prognosis and no apparent relation to systemic amyloidosis. Biopsy may be useful in determination of progression. Diffusion tractography is a valuable tool for minimizing resection associated complications.