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

Papadimitriou, Kyriakos; Rocca, Alda; Dunet, Vincent; Daniel, Roy Thomas

doi:10.1016/j.heliyon.2020.e04071

Cited by 8 publications

(14 citation statements)

References 21 publications

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“…Of the brain tumours associated with cerebral aneurysms in neurosurgical practice, meningiomas are the commonest [ 6 ]. Several hypotheses have been proposed to explain the possible causal association of tumour with aneurysm, including increase in the directional blood flow due to a higher blood supply (meningioma, malignant glioma), hormonal influence of IGF-1 on artery walls (artery dilation, atherosclerotic and degenerative changes) and genetic predisposition, tumour invasion and tumour-directed neo-vascularization, and previous intracranial tumour surgery causing traumatic aneurysms [ 1 , 3 , 6 ]. An aneurysm may develop on the artery feeding a large meningioma due to the haemodynamic stresses on these feeding arteries caused by the increased blood flow to the meningioma [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Sellar brain tumour co-existing with a left posterior communicating aneurysm causing ptosis: lessons learnt (case report)

Onyiab¹,

Ojoa²,

Arekhandiaa³

2023

Pan Afr Med J

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Posterior communicating aneurysm (PCOM) commonly presents with ptosis of the eye. This is so also with space occupying lesion compressing the oculomotor nerve. It is quite uncommon for a patient to have both lesions at the same anatomical space concurrently causing ptosis. If undiagnosed before surgical intervention, surgical complications from such a complex neurosurgical problem can be extremely devastating. We share our recent experience with confusing clinical presentation and subsequent treatment of a sellar brain mass co-existing with a left posterior communicating artery aneurysm at the same location in a 48 years old woman who was successfully managed with left pterional craniotomy and clipping of the PCOM aneurysm followed by gross total excision of the lesion. She improved with full resolution of left ptosis within 2 months. The histology revealed WHO Grade 1 psammomatous meningioma. Although similar sorts of pathologies occurring together have been described in the literature, this unique experience underscores the importance of thoroughly evaluating neurosurgical cases clinically irrespective of findings from radiologic investigations in order to prevent unexpected intra-operative disasters and embarrassment. Moreso, this is important particularly in Africa where advanced investigations to easily identify such complex pathologies are not readily available.

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Section: Discussionmentioning

confidence: 99%

Sellar brain tumour co-existing with a left posterior communicating aneurysm causing ptosis: lessons learnt (case report)

Onyiab¹,

Ojoa²,

Arekhandiaa³

2023

Pan Afr Med J

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“…The treatment strategy for meningioma coexisting with UCA has not been established and is controversial [ 2 , 4 , 5 , 7 – 9 ]. The consensus is that lesions with symptoms might be prioritized for treatment [ 4 – 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…UCA co-existence of meningiomas can be divided into three categories: UCAs unrelated to tumor feeders, UCAs encased in or near to the meningioma, and UCAs related to tumor feeders [ 2 , 6 , 8 , 11 – 15 ] such as in our case. There are no reports on the rupture rate of UCA after meningioma resection; however, there are reports regarding treatment of UCAs followed by meningioma resection or UCAs and meningioma treated at the same time [ 4 , 5 , 9 , 15 ]. This indicates that treatment of UCAs might not be considered essential because there are cases in which UCAs disappeared after meningioma removal [ 12 ] and no report of ruptured UCAs in follow-up after meningioma removal.…”

Section: Discussionmentioning

confidence: 99%

“…Statistical studies of meningioma coexisting with UCA have reported a frequency of 1.1 − 7.7% [ 3 – 6 ]. The treatment guidelines for meningioma coexisting UCAs have not been established, and the treatment priority is controversial [ 4 , 5 , 7 – 9 ]. We encountered a case of right frontal convexity meningioma coexisting with left UCA related to a tumor feeder.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…While there are several reports of aneurysms associated with brain tumors, [12][13][14] there are no definitive guidelines for the optimal treatment strategy. Zhong et al 14 described a case series of 12 patients who underwent combined management of concurrent brain tumors and aneurysms and proposed a therapeutic strategy based on location of the aneurysm in relationship to the tumor.…”

Section: Observationsmentioning

confidence: 99%

Vascular steal and associated intratumoral aneurysms in highly vascular brain tumors: illustrative case

Hong¹,

Marianayagam²,

Morales-Valero³

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Intratumoral aneurysms in highly vascular brain tumors can complicate resection depending on their location and feasibility of proximal control. Seemingly unrelated neurological symptoms may be from vascular steal that can help alert the need for additional vascular imaging and augmenting surgical strategies. OBSERVATIONS A 29-year-old female presented with headaches and unilateral blurred vision, secondary to a large right frontal dural-based lesion with hypointense signal thought to represent calcifications. Given these latter findings and clinical suspicion for a vascular steal phenomenon to explain the blurred vision, computed tomography angiography was obtained, revealing a 4 × 2–mm intratumoral aneurysm. Diagnostic cerebral angiography confirmed this along with vascular steal by the tumor from the right ophthalmic artery. The patient underwent endovascular embolization of the intratumoral aneurysm, followed by open tumor resection in the same setting without complication, minimal blood loss, and improvement in her vision. LESSONS Understanding the blood supply of any tumor, but highly vascular ones in particular, and the relationship with normal vasculature is undeniably important in avoiding potentially dangerous situations and optimizing maximal safe resection. Recognition of highly vascular tumors should prompt thorough understanding of the vascular supply and relationship of intracranial vasculature with consideration of endovascular adjuncts when appropriate.

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

Cited by 8 publications

References 21 publications

Sellar brain tumour co-existing with a left posterior communicating aneurysm causing ptosis: lessons learnt (case report)

Sellar brain tumour co-existing with a left posterior communicating aneurysm causing ptosis: lessons learnt (case report)

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

Vascular steal and associated intratumoral aneurysms in highly vascular brain tumors: illustrative case

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