- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
DOI:10.25259/SNI_811_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Hideki Kuroda, Masatoshi Takagaki, Hirayama Ryuichi, Matsui Yuichi, Takeo Nishida, Hajime Nakamura, Haruhiko Kishima. A case of meningolacrimal artery aneurysm associated with meningioma. 17-Feb-2021;12:61
How to cite this URL: Hideki Kuroda, Masatoshi Takagaki, Hirayama Ryuichi, Matsui Yuichi, Takeo Nishida, Hajime Nakamura, Haruhiko Kishima. A case of meningolacrimal artery aneurysm associated with meningioma. 17-Feb-2021;12:61. Available from: https://surgicalneurologyint.com/surgicalint-articles/10592/
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.
Keywords: Interventional radiology, Intraorbital aneurysm, Meningioma, Meningolacrimal artery
Intraorbital aneurysms are a rare occurrence, and most of them originate from the ophthalmic artery. A standard treatment for these aneurysms is yet to be established. We report a case of a meningolacrimal artery aneurysm of the feeding artery associated with a frontal convexity meningioma. The patient has provided informed consent to publish this report.
Case presentation and imaging
A 55-year-old woman was incidentally found to have a brain tumor on brain magnetic resonance imaging (MRI) at a checkup. The tumor was considered to be a frontal convexity meningioma based on contrast-enhanced brain MRI, and tumor resection was planned after informed consent was obtained [
(a and b): T1-weighted axial (a) and sagittal (b) contrast-enhanced magnetic resonance imaging (MRI) showing a meningioma in the right convexity region, (c) T1-weighted axial contrast-enhanced MRI showing the aneurysm in the orbital cavity (white arrow), (d and e) frontal (d) and side (e) views by angiography of the right external carotid showing that the meningioma had blood flow mainly from the middle meningeal artery and the presence of a right intraorbital aneurysm, (f) axial imaging of enhanced cone-beam computed tomography showing that the aneurysm is associated with the meningolacrimal artery through the cranio-orbital foramen (white arrow head) and is present in the orbit cavity (white arrow).
Embolization of the feeding artery was performed before resecting the meningioma to reduce intraoperative bleeding. We normally use N-butyl-2-cyanoacrylate (NBCA) for embolization of a feeding artery. Therefore, to prevent the migration of NBCA into the ophthalmic artery, we decided to occlude the meningolacrimal artery proximal to the aneurysm before injection of NBCA. The procedure was performed under local anesthesia. A 5-Fr long sheath was placed into the right femoral artery. A 5-Fr guiding catheter (ENVOY; Johnson and Johnson, New Brunswick, NJ) was placed into the right external carotid artery, and a microcatheter (Marathon; Medtronic, Dublin, Ireland) was placed into the meningolacrimal artery using a microguidewire (CHIKAI10; Asahi Intecc, Aichi, Japan). Then, five detachable coils (ED coil; Kaneka Corporation, Tokyo, Japan) were inserted into the meningolacrimal artery [
(a) The right external carotid angiography in the oblique view showing the blood supply for the meningioma and the aneurysm, (b) the right external carotid angiography showing insertion of coils in the meningo-lacrimal artery, (c) the right external carotid angiography after interventional radiology showing remaining blood supply from the superficial temporal artery (arrow).
Resection of the meningioma
We performed an orbitofrontal craniotomy for resection of the meningioma [
(a) Three-dimensional computed tomography showing right fronto-orbital craniotomy, (b) a photograph of the fronto-orbital bone flap with the aneurysm (white arrow), (c and d) T1-weighted axial (c) and sagittal (d) contrast-enhanced magnetic resonance imaging showing resection of the meningioma and aneurysm.
Intraorbital aneurysms are rare – there are only 22 reported cases to the best of our knowledge,[
The natural history of intraorbital aneurysms is unclear. There are few reports of spontaneous rupture, only two cases are reported.[
The prevalence of the cooccurrence of a brain tumor and an aneurysm is about 0.3–1%.[
We report a case of a meningolacrimal artery aneurysm associated with a frontal convexity meningioma. The artery was occluded before tumor resection, and the aneurysm was removed through craniotomy. Embolizing the feeding artery with the aneurysm was helpful in safely resecting the meningioma.
1. Garala P, Virdee J, Qureshi M, Gillow T. Intraorbital aneurysm of the ophthalmic artery. BMJ Case Rep. 2019. 12: e227044
2. Javalkar V, Guthikonda B, Vannemreddy P, Nanda A. Association of meningioma and intracranial aneurysm: Report of five cases and review of literature. Neurol India. 2009. 57: 772-6
3. Kim YH, Lee YJ, Han JH, Ahn S, Lee J, Kim JH. Association of intracranial aneurysms and meningiomas: A case-control study. J Neurosurg. 2015. 123: 357-61
4. Kirsch M, Henkes H. A ruptured intraorbital ophthalmic artery aneurysm, associated with a dural arteriovenous fistula: Combined transarterial and transvenous endovascular treatment. Minim Invasive Neurosurg. 2011. 54: 128-31
5. Meyerson L, Lazar SJ. Intraorbital aneurysm of the ophthalmic artery. Br J Ophthalmol. 1971. 55: 199-204
6. O’Neill OR, Barnwell SL, Silver DJ. Middle meningeal artery aneurysm associated with meningioma: Case report. Neurosurgery. 1995. 36: 396-8
7. Pia HW, Obrador S, Martin JG. Association of brain tumours and arterial intracranial aneurysms. Acta Neurochir (Wien). 1972. 27: 189-204
8. Tachikawa T, Adachi J, Nishikawa R, Matsutani R. An anterior ethmoidal artery aneurysm associated with an olfactory groove meningioma: Case illustration. J Neurosurg. 2002. 97: 1479
9. Tawfik HA, Habib MA. Intraorbital false (thrombosed) aneurysm of the meningolacrimal branch of the middle meningeal artery: A case report and an appraisal of anatomy. Ophthalmic Plast Reconstr Surg. 2011. 27: 387-90