Middle meningeal artery aneurysm associated with meningioma.

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.