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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Middle meningeal artery aneurysm: Case report
E Kpelao1, K A Beketi1, K M H Ahanogbe1
1Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo.
Background:
Aneurysms of meningeal middle artery (MMA) are extremely rare. These aneurysms are of two types: true aneurysm and pseudoaneurysm. The true type is usually seen with pathologic conditions. Pseudoaneurysms, on the other hand, are associated with a skull fracture. Epilepsy caused by MMA aneurysm has never been described to our knowledge. We report a case of true aneurysm isolated from MMA revealed by epilepsy.
Case Description:
A 57-year-old patient with a history of high blood pressure developed epilepsy which was treated by valproic acid. Initial scalp electroencephalography (EEG) showed seizure activity arising from the right temporal area. Epilepsy had become drug-resistant. Cerebral angiography revealed an aneurysm of the right middle meningeal artery without any other intraparenchymal anomaly. The interrogation did not reveal any history of family aneurysm. The patient underwent surgery with coagulation of the aneurysm and the MMA. The aneurysm was intradural in contact with the temporal cortex, and the surrounding brain tissues were preserved. The operative follow-up was favorable with amelioration of convulsions with a single antiepileptic. We planned to stop antiepileptic treatment according to electroencephalograms.
Conclusions:
Aneurysms of the MMA are rare. Their mode of revelation by seizures is unusual. The factors of rupture are not known. When isolated, their physiopathology is identical to that of the aneurysms of the Willis polygon. Their management uses the same techniques as for other cerebral aneurysms.
Insights
Middle meningeal artery (MMA) aneurysms are rare, and their presentation with epilepsy is highly unusual. This case highlights a true MMA aneurysm revealed by drug-resistant epilepsy, successfully treated with surgery.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Aneurysms of the middle meningeal artery (MMA) are exceptionally rare, with distinct types including true aneurysms (often pathological) and pseudoaneurysms (associated with fractures).
- Epilepsy as a presenting symptom of an MMA aneurysm has not been previously documented.
Observation:
- A 57-year-old patient with hypertension developed drug-resistant epilepsy originating from the right temporal area.
- Cerebral angiography identified an isolated right middle meningeal artery aneurysm without other intracranial abnormalities.
- The aneurysm was intradural, adjacent to the temporal cortex, and surgically treated via coagulation.
Findings:
- This case presents a rare instance of a true middle meningeal artery aneurysm manifesting solely as epilepsy.
- Surgical intervention involving aneurysm coagulation led to favorable outcomes with improved seizure control.
Implications:
- The unusual presentation of MMA aneurysms with seizures underscores the need for comprehensive diagnostic evaluation in refractory epilepsy cases.
- Management strategies for isolated MMA aneurysms are comparable to those for other intracranial aneurysms, with surgical coagulation demonstrating efficacy.
