gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Treatment of aneurysms in meningiomas: case report and literature review

Meeting Abstract

  • Niklas von Spreckelsen - Klinik für Neurochirurgie, Universitätsklinikum Köln, Köln, Germany
  • Thomas Liebig - Klinik für Radiologie, Universitätsklinikum Köln, Köln, Germany
  • Roland Goldbrunner - Klinik für Neurochirurgie, Universitätsklinikum Köln, Köln, Germany
  • Boris Krischek - Klinik für Neurochirurgie, Universitätsklinikum Köln, Köln, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 046

doi: 10.3205/16dgnc421, urn:nbn:de:0183-16dgnc4213

Published: June 8, 2016

© 2016 von Spreckelsen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The coexistence of aneurysms and meningiomas is rare, encasement of an aneurysm within a meningioma even more so. We report a case of an optic nerve sheath meningioma encasing an aneurysm of the internal carotid artery and deliver a brief review of the literature.

Method: A 57-year-old patient with a preexisting constant restriction of his right-sided vision over 16 years presented to our clinic after his vision began to worsen further over a course of 4 weeks, resulting in a complete loss of vision two weeks prior to admission. An unenhanced MRI revealed an intra- and retroorbital mass, consistent with an optic nerve sheath meningioma and two aneurysms. One emerging from the anterior communicating artery and the other from the right internal carotid artery. The latter was encased by the tumor. We undertook a literature search using the OVID gateway of the MEDLINE database using the MESH terms: aneurysm, meningioma.

Results: In order to prevent further strain of the chiasm and subsequent damage to the vision in the left eye, the optic chiasm was decompressed by means of intradural resection of the tumor. Due to the configuration of both aneurysms an endovascular or surgical approach without the sacrifice of several branches would have been challenging. Because there was no history of subarachnoid hemorrhage but substantial decrease in vision the treatment of the aneurysm was not considered a priority. The tumor was surgically resected to the extent that the pressure on the chiasm and left optic nerve was completely relieved (Simpson grade 3). The literature search resulted in five further reports of meningioma-encased-aneurysms in which different therapeutic approaches were used. Three of those five aneurysms had ruptured prior to treatment. One case control study showed that the incidence of aneurysms is significantly higher in meningioma patients compared to the general population (OR 2.913, 95% CI 1.613-5.261).

Conclusions: Treating a combination of an aneurysm and a tumor presents a special challenge especially if the tumor is immediately adjacent to the aneurysm. While in the case of intratumoral aneurysm it has been suggested to occlude the aneurysm first and then address the tumor, in our case it did not seem reasonable due to the morphology and innocence of the aneurysm. Earlier research suggested that the combination of meningiomas and aneurysms was merely accidental, a recent study suggests otherwise.