• Rebecca Gillian Macfarlane, Malcolm Galloway, Piers Nicholas Plowman, and David Glyndor Treharne Thomas.
• Division of Neurosurgery, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
• Neurosurgery. 2005 Jun 1; 56 (6): E1378; discussion E1378.

Objective And ImportanceA case of an unusual intracranial solitary fibrous tumor with features of high vascularity and resultant difficulty at resection is presented. The use of surgery, radiotherapy, and toremifene has been successful with no recurrence after 18 months.Clinical PresentationA 33-year-old male patient presented with a 1-year history of loss of vision on the left side and a 3-month history of headache and lethargy. Magnetic resonance imaging showed a lobulated mass (7.6 x 4.5 cm) in the left temporal fossa and left parasellar, sellar, and suprasellar regions, with a "dural tail" more typical of meningioma. Vascular supply was from both the internal carotid arteries and the left middle meningeal artery, precluding embolization.InterventionAt the time of the craniotomy, a highly vascular tumor was found. Intraoperative hemorrhage limited resection to 20% of the tumor. The histological diagnosis was of a solitary fibrous tumor with an unusually angiomatoid architecture. After the operation, radiotherapy and toremifene were administered. A dramatic reduction in the size of the tumor was seen with no recurrence to date.ConclusionThe use of surgery, radiotherapy, and toremifene in treatment of a vascular intracranial solitary fibrous tumor has been successful and warrants further research.

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