An anterior ethmoidal artery aneurysm associated with an olfactory groove meningioma. Case illustration

A rare case of a right infratentorial meningioma and a left giant posterior communicating thrombosed aneurysm

Background

Giant intracranial aneurysms cause symptoms due to mass effect and can mimic other lesions in imaging studies. The coexistence of tumors and aneurysms is relatively rare, with meningiomas being the predominant tumors found in such cases. The relationship between these two entities is complex and represent a neurosurgical challenge.

Case Description

A 61-year-old woman presented with intermittent headache, vertigo, right peripheral facial palsy, hearing loss, and left hemiparesis. Magnetic resonance imaging revealed two lesions: a supratentorial paraclinoid lesion in the left frontotemporal region and a right infratentorial extra-axial mass, suggestive of a meningioma. The patient underwent a two-staged surgical intervention to address both lesions.

Conclusion

In this particular case, the lesions were located on different sides and in different cranial compartments, making it even rarer.

Case report and literature review: Treatment of multiple meningiomas combined with multiple unruptured aneurysms in a single operation

Background

Although the incidence of a single meningioma or a single aneurysm is common, cases of multiple meningiomas combined with multiple aneurysms are rarely reported, and surgical treatment of the coexisting situation is also relatively uncommon.

Case presentation

A 38-year-old male patient presented to the neurosurgery department of our center with a headache. Examination revealed only symptoms of headache. Laboratory tests showed only decreased total protein and albumin. Magnetic resonance imaging showed preoccupation with the frontal lobe and the right temple bone. Magnetic resonance angiography and digital subtraction angiography showed two aneurysms in the anterior communicating artery and right anterior cerebral artery. Based on a combination of the patient’s history and imaging, we hypothesized that the patient was simultaneously suffering from meningioma and an aneurysm, and both of them are multiple. The patient underwent tumor resection and clipping procedure based on this hypothesis in one surgery. Intraoperative biopsy proved to be a meningioma. The patient was discharged on the 10th postoperative day, and a postoperative follow-up suggested no complications.

Conclusion

Multiple meningiomas combined with multiple aneurysms are rare to be reported in the same patient. For those unruptured intracranial aneurysms (UIAs) located in the visual field of craniotomy prepared for brain tumorlike meningioma, it is possible to do the clipping as well. When the meningiomas are multiple, fitted with the surgical indication, and located in a position that cannot be treated in one surgery, this may lead to a two-stage operation, no matter where the UIAs are located.

Intraoperative rupture of intracerebral aneurysm immediately after meningioma resection: a case report

Background

Meningiomas and unruptured cerebral aneurysms (UCAs) rarely coexist. However, the treatment strategy remains to be fully elucidated. This report is a first report that UCA related to the tumor feeder intraoperatively ruptured when the meningioma was resected.

Case presentation

Herein, we present a case of meningioma coexisting with contralateral UCA related to a tumor feeder. Immediately after the meningioma was resected, intraoperative acute brain swelling due to rupture of the contralateral aneurysm appeared. The swollen brain protruding into the epidural space was resected, following contralateral ruptured aneurysm was performed by endovascular surgery. Intensive neurological treatment was administered and the patient gradually recovered.

Conclusion

This report highlights the possibility of intraoperative UCA rupture related to the tumor feeder when the meningioma is resected.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02664-8.

Bilateral aneurysms, one of which is embedded in a meningioma: a rare case report and literature review

BACKGROUND

Although the coexistence of primary brain neoplasms with intracranial aneurysms is rare, this phenomenon has become more recognized. Meningioma is the most frequently occurring type of tumor associated with an aneurysm. However, meningiomas encasing aneurysms are extremely rare, posing a diagnostic and therapeutic challenge to healthcare providers.

CASE DESCRIPTION

We report a case of a 46-year-old female patient admitted to our hospital with headache and dizziness for ten years. Enhanced magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) indicated a mass in the right sphenoid ridge, surrounding a posterior communicating artery aneurysm of the right internal carotid artery. Digital subtraction angiography (DSA) revealed left ophthalmic segment aneurysm and right posterior communicating artery aneurysm. We first clipped the aneurysm and then removed intracranial tumor during the same operation. The postoperative pathological diagnosis of tumor was meningioma (World Health Organization grade I). The patient's postoperative course was uneventful, with only a mild reduction in lateral vision of both eyes.

CONCLUSIONS

We reported a rare case in which an intracranial aneurysm was encased in a meningioma and could be safely treated during the same operation. Notably, embolizing or clipping aneurysm first and then removing intracranial tumor appears to enhance the safety of patients. This is the best treatment option if the aneurysm and meningioma can be treated concurrently in the hybrid operating room. Additionally, it may be necessary to carefully evaluate preoperative MRA or computed tomography angiography (CTA), and it is critical to confirm the existence of any vascular lesions in patients with brain tumors using MRA or CTA.

A case of meningolacrimal artery aneurysm associated with meningioma

Background

Intraorbital aneurysms are rare, and most of them originate from the ophthalmic arteries. Herein, we report a case of meningolacrimal artery aneurysm associated with a meningioma.

Case Description

A 55-year-old woman had a frontal convexity meningioma identified by brain magnetic resonance imaging during a checkup. Cerebral angiography revealed the middle meningeal artery as a feeding artery as well as the presence of an aneurysm associated with the meningolacrimal artery. Embolization of the feeding artery was performed before the removal of the meningioma. The meningioma was resected, and the aneurysm was removed with a bone flap. The patient was discharged without any complications.

Conclusion

We report a meningolacrimal artery aneurysm associated with a meningioma. Embolizing the feeding artery of the aneurysm was helpful in safely resecting the meningioma.

Association between intracranial aneurysm and meningiomas: An integrative survival Analysis with identification of prognostic factors

OBJECTIVE

To analyze prognostic factors in clinical association between intracranial aneurysm (IA) and meningioma. Prognostic factors on overall survival (OS) were evaluated.

METHODS

We selected articles, published from January 1944 to December 2018 on the Medical databases (Web of Sciences, Medline and EMBASE) and included case series and reports. Clinical information was obtained and variables associated with the primary outcome of 27-mo survival were identified through Cox regression models.

RESULTS

The study evaluated 77 patients. Female represented 76.6 % (n = 59), a ratio of 3.27 female: 1 male. The age range was 7-84 years old, with an average of 54.74 (SD: 14.30). Age and sex were not significant statistically different between the two groups for overall survival (OS) (log-rank P = 0.806), (log-rank P = 0.983) respectively. 77.9 % (n = 60) were ipsilateral, the same side was 4 times more common in univariate analysis (P = 0.052; 95 % CI, 0.924-17.319). Most aneurysms were detected in the internal carotid artery, 29.87 %. In Clinical data, 62.33 % (n = 48) had exclusive tumor symptoms, while 25.97 % (n = 20) presented exclusively subarachnoid hemorrhage (SAH). In multivariate analysis, although there is an independent protective factor for those who did not have SAH (HR; 0.099; CI; 0.010-0.986; P = 0.049) and the treatment is an independent predictor for OS (HR, 42.096; CI, 4.270-415.056; P = 0.01).

CONCLUSION

This is the first study to approach this association. This is not just an occasional finding, but it seems to have a shared pathophysiology. Unruptured aneurysms and treatment modality were protective independent factors for OS. Prospective studies are warranted to provide definitive answers.

Feeding artery aneurysms associated with large meningiomas: case report and review of the literature

Though brain tumors and intracranial aneurysms co-exist, the occurrence of feeding artery aneurysms with meningiomas are unusual. We describe here a large falcine meningioma that was associated with three feeding artery aneurysms of the anterior circulation. These aneurysms can be treated either by pre-operative endovascular therapy or during the meningioma surgery. The management strategy for these patients will depend on the clinical presentation, morphology and localization of these aneurysms with respect to the tumor.

Association of intracranial aneurysms and meningiomas: a case-control study

OBJECT

The authors aimed to assess whether the prevalence of intracranial aneurysms in patients with intracranial meningiomas was higher than that in a healthy population.

METHODS

The authors performed a hospital-based case-control study of 300 patients with newly diagnosed intracranial meningiomas and 900 age- and sex-matched controls without a history of brain tumors to evaluate any associations between intracranial aneurysms and intracranial meningiomas. Unconditional multivariate logistic regression models were used for case-control comparisons.

RESULTS

Intracranial aneurysms were identified in 23 patients (7.7%) and 24 controls (2.7%; p < 0.001). There was a significant association between intracranial aneurysms and intracranial meningiomas (OR 2.913, 95% CI 1.613–5.261) and hypertension (OR 1.905, 95% CI 1.053–3.446). In a subgroup analysis of the patients with newly diagnosed intracranial meningiomas, there was a significant association between intracranial aneurysms and hypertension (OR 2.876, 95% CI 1.125–7.352) and tumor volume (OR 1.012, 95% CI 1.001–1.024). These patients were also more likely than controls to have other intracranial vascular diseases (p < 0.001), such as isolated occlusion of the intracranial vessels, excluding intracranial aneurysms.

CONCLUSIONS

The prevalence of intracranial aneurysms was higher in patients with intracranial meningiomas. Hypertension and tumor volume appear to be associated with the formation of intracranial aneurysms in these patients.

Endoscopic skull base surgery: a comprehensive comparison with open transcranial approaches

Little data exists comparing endoscopic endonasal approaches to pathology of the anterior skull base with more traditional transcranial and transsphenoidal microscopic approaches. In order to more fully characterize the role of endoscopy in the management of pathology of the anterior cranial base, we conducted a systematic review of case series and case reports documenting surgical and clinical outcomes. We found that for craniopharyngiomas, clival chordomas, esthesioneuroblastomas and giant pituitary adenomas, the endonasal endoscopic approach can result in equivalent or higher rates of gross total resection than open approaches. For meningiomas, however, open transcranial approaches are still able to achieve higher rates of total resection. CSF leak rates are higher for patients undergoing endoscopic surgery for meningiomas and craniopharyngiomas, but not for chordomas, esthesioneuroblastomas or giant pituitary adenomas. In certain patients, the endonasal endoscopic approach may be a safe and effective alternative for the treatment of a wide variety of skull base pathology, particularly those with small midline tumours.

Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas

OBJECTIVE

To assess the advantages and limitations of the endoscopic endonasal approach to anterior skull base meningiomas, a minimally invasive approach that avoids extensive bone drilling, brain retraction, and manipulation of nerves and critical vessels, versus open transcranial surgery.

METHODS

A MEDLINE (2000-2010) search was performed to identify series for either olfactory groove meningiomas or tuberculum sellae (TS) or planum sphenoidale meningiomas. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were performed using χ(2) and Fisher exact tests.

RESULTS

The literature review included 60 studies, involving 1426 patients. Open surgery achieved a higher rate of gross total resection (GTR) for both olfactory groove (P < 0.001) and TS and planum (P < 0.001) meningiomas. Postoperative cerebrospinal fluid (CSF) leak occurred more frequently in the endoscopic cohort (P < 0.001). Other postoperative complications occurred more frequently in the open cohort, although this difference was not statistically significant. There were no significant differences in postoperative visual outcome between the groups.

CONCLUSIONS

Based on the current literature, open transcranial approaches for olfactory groove and TS and planum sphenoidale meningiomas still result in higher rates of total resection with lower postoperative CSF leak rates. The endoscopic endonasal approach may be safe and effective for certain skull base meningiomas; careful patient selection and multilayer closure techniques are essential.

Peripheral ophthalmic artery aneurysm

Generally speaking, the term "ophthalmic aneurysms" refers to carotid-ophthalmic aneurysms, which arise from the internal carotid artery (ICA) wall at or around the origin of the ophthalmic artery (OA). In contrast, aneurysms arising from the OA stem or its branches, separate from the ICA are called peripheral OA aneurysms (POAAs). POAAs are a rare entity, which clinical features and natural course are not fully understood. A comprehensive literature review of reported aneurysms involving each segment of the OA was undertaken. The demographics, aetiology, clinical manifestations and treatment of reported POAAs are discussed. Of 35 retrieved cases, ten involved the intracranial segment, two were fusiform aneurysms in the optic canal, 17 arose from the intraorbital segment, and 6 involved either the lacrimal or the anterior ethmoidal branches. In 34 cases, clinical details were available; 18 patients experienced moderate to severe visual impairment including blindness, while seven patients had improvement in visual acuity as a result of surgical treatment. The present clinical review reveals that aneurysms of the OA stem and lacrimal branch are potentially threatening to visual acuity, while intracranial segment and anterior ethmoidal aneurysms can rupture and cause subarachnoid or intraparenchymal haemorrhage. Surgical intervention is mandatory in symptomatic cases to prevent visual deterioration or treat aneurismal rupture; alternatively, for small incidental POAAs "watchful waiting" may be indicated.