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Middle meningeal artery aneurysms: Etiology, presentation, management, and outcomes - A systematic review
Ali K Al-Shalchy1, Nooruldeen H Ali Al-Khafaji1, Mustafa Ismail2
1Department of Surgery, University of Baghdad, Baghdad, Iraq.
Background:
Middle meningeal artery (MMA) aneurysms are uncommon vascular abnormalities, typically documented through isolated case reports and small case series. Their clinical features, causes, and treatment options are not yet fully understood.
Methods:
A systematic review of the literature was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Included were published case reports and case series that described pure MMA aneurysms. The methodological quality was evaluated with the Joanna Briggs Institute critical appraisal tools for case reports and case series. Data were collected at the individual patient level and summarized descriptively using counts and percentages.
Results:
Thirty-eight studies comprising 42 patients were included. Male predominance was observed (66.7%). Traumatic (52.4%) and iatrogenic (23.8%) etiologies were most common, with additional vasculopathic, infectious, genetic, and spontaneous causes reported. Most patients presented with intracranial hemorrhage (81.0%), most commonly epidural hematoma. Pseudoaneurysms predominated (78.6%), and distal MMA involvement was frequent (69.0%). Management strategies were heterogeneous, including combined surgical and endovascular treatment (40.5%), endovascular treatment alone (26.2%), surgical treatment alone (23.8%), and conservative management (9.6%). Favorable functional outcomes (modified Rankin scale 0-2) were reported in 88.1% of cases, and mortality was 11.9%. No aneurysm recurrence was reported during available follow-up. Overall risk of bias was moderate, reflecting incomplete reporting inherent to case-based evidence.
Conclusion:
MMA aneurysms are uncommon, diverse lesions commonly linked to trauma or iatrogenic injury, often presenting with hemorrhage. Treatment approaches are personalized, and prognosis is usually positive. To enhance understanding and inform future management, standardized reporting and collaborative data collection are necessary.
Insights
Middle meningeal artery (MMA) aneurysms are rare vascular issues, often caused by trauma or medical procedures. While typically presenting with hemorrhage, most patients achieve good outcomes with personalized treatment.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- Middle meningeal artery (MMA) aneurysms are uncommon vascular abnormalities.
- Their clinical features, causes, and treatment options require further elucidation.
Purpose of the Study:
- To systematically review the literature on pure MMA aneurysms.
- To understand the clinical characteristics, etiologies, and management of MMA aneurysms.
Main Methods:
- Systematic literature review following PRISMA guidelines.
- Inclusion of case reports and case series describing pure MMA aneurysms.
- Methodological quality assessment using Joanna Briggs Institute tools and descriptive data summarization.
Main Results:
- 42 patients from 38 studies were analyzed, with a male predominance (66.7%).
- Traumatic (52.4%) and iatrogenic (23.8%) causes were most frequent; 81.0% presented with intracranial hemorrhage.
- Pseudoaneurysms (78.6%) and distal MMA involvement (69.0%) were common; management varied, with favorable outcomes (88.1%) and 11.9% mortality.
Conclusions:
- MMA aneurysms are diverse lesions often linked to trauma or iatrogenic injury, frequently presenting with hemorrhage.
- Personalized treatment approaches yield positive prognoses, with no reported recurrence.
- Standardized reporting and collaborative data collection are essential for advancing understanding and management.
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