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Middle meningeal artery aneurysm associated with meningioma
1Department of Neurosurgery, Ospedale Loreto Nuovo, Napoli, Italy.
Abstract:
The aneurysms of the middle meningeal artery are extremely rare. 30 pseudoaneurysms of the middle meningeal artery (MMA) are reported in literature. These are post-traumatic lesions different from the true aneurysms that have a different origin. In fact they can be associated with arteriovenous malformations, Paget's disease and tumors; nevertheless in some cases the genesis remains unknown. Sometimes the berry aneurysm of MMA can cause non traumatic extradural hematomas. The association meningioma-aneurysm of the middle meningeal artery is extremely rare: only a case has been signalled till now in literature. In our case the patient was a 69 year-old woman admitted in our department following an epileptic seizure. Neuroradiological studies (post-contrast CT and RM) showed a meningioma of the right pterion. A preoperative angiography evidenciated a big blush from the afferences of meningioma by the middle meningeal artery and, proximally a small berry aneurysm of this artery. Selective embolization of the tumor and the aneurysm was performed preoperatively with polyvinyl particles and straight platinum coils. A craniotomy a surgical resection of the meningioma were performed. The role of the endovascular treatment in the management of these lesions is underlined to decrease the risks of morbidity.
Insights
Middle meningeal artery aneurysms are rare, often post-traumatic. This case highlights a rare association with meningioma, successfully treated with endovascular embolization and surgical resection.
Area of Science:
- Neurology
- Vascular Surgery
- Neuroradiology
Background:
- Aneurysms of the middle meningeal artery (MMA) are exceptionally rare, with only 30 pseudoaneurysms documented.
- True aneurysms of the MMA, distinct from pseudoaneurysms, can arise from various conditions including arteriovenous malformations, Paget's disease, and tumors, or have unknown origins.
Observation:
- A 69-year-old woman presented with an epileptic seizure, revealing a right pterion meningioma on imaging.
- Preoperative angiography identified significant tumor vascularity supplied by the MMA and a coexisting proximal MMA berry aneurysm.
Findings:
- The study reports an extremely rare case of concurrent meningioma and middle meningeal artery aneurysm.
- Successful preoperative endovascular embolization of both the tumor afferences and the aneurysm was achieved using polyvinyl particles and platinum coils.
Implications:
- This case underscores the importance of preoperative embolization in managing complex neurovascular lesions.
- Endovascular treatment can significantly reduce morbidity associated with surgical resection of meningiomas associated with MMA aneurysms.