Middle meningeal artery aneurysm: Case report

Abstract

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.

Spontaneous Middle Meningeal Artery Aneurysms: A Case Report and Review of the Literature

“…A significant number of the reported cases presented with loss of consciousness secondary to aneurysm rupture [7][8][9][10][11], with a variable presentation at the site of the bleeding (Table 2). Aneurysms were predominantly located in the proximal MMA [9,[12][13][14][15][16], and the size was less than 10 mm for most cases, with the exception of a giant MMA aneurysm that was reported in a patient with fibrous dysplasia [14]. Some of the conditions associated with the reported cases of spontaneous MMA aneurysm were hypertension [9,12,13,17,18], neurofibromatosis type 2 [19], Paget's disease of the bone [12,17,18], and intracranial meningiomas [15,[19][20][21][22][23].…”

“…Aneurysms were predominantly located in the proximal MMA [9,[12][13][14][15][16], and the size was less than 10 mm for most cases, with the exception of a giant MMA aneurysm that was reported in a patient with fibrous dysplasia [14]. Some of the conditions associated with the reported cases of spontaneous MMA aneurysm were hypertension [9,12,13,17,18], neurofibromatosis type 2 [19], Paget's disease of the bone [12,17,18], and intracranial meningiomas [15,[19][20][21][22][23]. In terms of management, most unruptured cases underwent endovascular treatment with glue embolization [10,14,19].…”

“…In terms of management, most unruptured cases underwent endovascular treatment with glue embolization [10,14,19]. For cases reporting an associated intracranial hemorrhage, a craniotomy with ligation and coagulation was performed [8,9,[11][12][13]24]. Regarding outcomes, most patients recovered to baseline when identified and treated before rupture.…”

“…Endovascular management emerges as an alternate approach, with positive outcomes reported for various embolic agents such as glue, coils, and PVA [ 10 , 14 , 15 , 19 , 20 , 22 , 23 ]. However, positive results were also seen in patients with unruptured aneurysms undergoing craniotomy [ 13 , 16 ], which can be minimally invasive with a small burr hole. In our case, we report the use of primary coiling with angiographic obliteration and symptom resolution.…”