Preoperative DSA-guided embolization combined with surgical resection for the treatment of intratumoral hemorrhage in plexiform neurofibroma: a case report.

Background: Neurofibromatosis type 1 (NF1) is a neurocutaneous genetic disorder. Plexiform neurofibromas (PNFs), occurring in a subset of patients, carry a risk of significant hemorrhage, which can be life-threatening. Case presentation: A 61-year-old woman with NF1 presented with a rapidly enlarging, painful left buttock mass after trauma. Imaging confirmed a PNF with intratumoral hemorrhage. She underwent preoperative digital subtraction angiography (DSA) with embolization of tumor-feeding arteries, followed by successful complete surgical resection. At 6-month follow-up, the patient remained free of recurrent hemorrhage, with satisfactory wound healing and significant improvement in pain and mobility. Discussion: Giant plexiform neurofibromas complicated by acute hemorrhage represent a rare but clinically challenging manifestation of NF1. This case demonstrates that a staged strategy combining preoperative DSA-guided embolization and surgical resection within a multidisciplinary framework can effectively control bleeding and optimize perioperative safety. Comprehensive risk assessment, including vigilance for thromboembolic complications, is essential in high-risk surgical patients. Given the lifelong risk of malignant transformation, long-term surveillance and consideration of targeted therapy remain critical, although real-world accessibility may limit implementation. Conclusion: Preoperative embolization followed by resection represents a safe and effective multidisciplinary strategy for controlling acute, life-threatening hemorrhage in NF1-associated PNF. Similarly, perioperative surveillance and long-term follow-up remain essential for achieving optimal clinical outcomes.