Onyx embolization of an intraosseous pseudoaneurysm of the middle meningeal artery in a patient with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome

Coexistence of meningioma and craniofacial fibrous dysplasia: a case series of clinicopathological study and literature review

BACKGROUND

The co-existence of meningioma and craniofacial fibrous dysplasia (CFD) is rare. Due to the similar radiological characteristics, it is challenging to differentiate such co-existence from solitary hyperostotic meningioma resulting in a dilemma of prompt diagnosis and appropriate intervention.

METHOD

We conducted a retrospective review of the data from 21 patients with concomitant meningioma and CFD who were treated at Beijing Tiantan Hospital from 2003 to 2021. We summarized their clinicopathological features and performed a comprehensive literature review. Additionally, we tested the characteristic pathogenic variants in exon 8 and 9 of GNAS gene and the expression of corresponding α-subunit of the stimulatory G protein (Gαs) related to CFD to explore the potential interactions between these two diseases.

RESULTS

The cohort comprised 4 men and 17 women (mean age, 45.14 years). CFD most commonly involved the sphenoid bone (n = 10) and meningiomas were predominantly located at the skull base (n = 12). Surgical treatment was performed in 4 CFD lesions and 14 meningiomas. Simpson grade I-II resection was achieved in 12 out of the 14 resected meningiomas and almost all of them were classified as WHO I grade (n = 13). The mean follow-up duration was 56.89 months and recurrence was noticed in 2 cases. Genetic study was conducted in 7 tumor specimens and immunohistochemistry was accomplished in 8 samples showing that though GNAS variant was not detected, Gαs protein were positively expressed in different degrees.

CONCLUSIONS

We presented an uncommon case series of co-diagnosed meningioma and CFD and provided a detailed description of its clinicopathological features, treatment strategy and prognosis. Although a definite causative relationship had not been established, possible genetic or environmental interplay between these two diseases could not be excluded. It was challenging to initiate prompt diagnosis and appropriate treatment for concomitant meningioma and CFD because of its similar radiological manifestations to meningioma with reactive hyperostosis. Personalized and multi-disciplinary management strategies should be adopted for the co-existence of meningioma and CFD.

Spontaneous intracerebral pseudoaneurysm rupture and meningiomatosis: A case report and review of the literature

Background:

We report the first case of a spontaneous ruptured anterior cerebral artery pseudoaneurysm in a patient affected by meningiomatosis.

Case Description:

A 71-year-old female patient was admitted to our emergency department after acute loss of consciousness. An urgent head CT scan showed third ventricle hemorrhage and a giant extra-axial tumor with associated peritumoral bleeding. A second, smaller, and right-sided tumor was detected at the posterior third of the superior sagittal sinus, indicative of meningiomatosis diagnosis. A following CT angiogram showed an hypervascularized lesion at the right frontal convexity and a ruptured A2 pseudoaneurysm. Tumor removal was performed through right frontal craniotomy. After the initial debulking and removal of the peritumoral hemorrhage, the A2 segment associated with the bleeding pseudoaneurysm was surgically coagulated.

Conclusion:

We report the unique occurrence of two relatively rare neurological entities: meningiomatosis and intracranial pseudoaneurysm. In our experience, their simultaneous and acute presentation is associated to poor prognosis.

Co-existing of craniofacial fibrous dysplasia and cerebrovascular diseases: a series of 22 cases and review of the literature

Background

Craniofacial fibrous dysplasia is a fairly rare condition. Some literature have reported a few patients with craniofacial fibrous dysplasia suffering from vascular abnormalities. This study aimed to describe the possible coexistence of craniofacial fibrous dysplasia and cerebrovascular diseases for the first time.

Method

We retrospectively reviewed the 1175 patients with craniofacial fibrous dysplasia in Beijing Tiantan Hospital and the information of the 22 patients coexisted with cerebrovascular diseases were described. In addition, we performed a systematic review for cases of craniofacial fibrous dysplasia with vascular abnormalities.

Result

22 out of 1175 patients (1.9%) were diagnosed with craniofacial fibrous dysplasia and cerebrovascular diseases including 9 intracranial aneurysms, 4 venous malformations, 2 arteriovenous malformations, 1 moyamoya disease, 2 intracranial venous stenosis and 4 cerebral ischemia with a mean age of 38.18 years old. Only 2 patients were managed surgically for craniofacial fibrous dysplasia and 6 patients were treated with neurosurgery for cerebrovascular diseases. 8 patients were closely followed and only 1 patient’s symptoms worsened.

Conclusion

Craniofacial fibrous dysplasia might cause constriction of the intracranial vessels and alteration of the overall hemodynamics of the intracranial vasculature resulting in various cerebrovascular diseases. Multimodal screening and examinations seems reasonable for patients with craniofacial fibrous dysplasia for throughout treatment and prognosis evaluations.

Thrombosed Middle Meningeal Artery Aneurysms Mimicking Aneurysmal Bone Cysts in a Patient with Fibrous Dysplasia

BACKGROUND

The aneurysmal bone cyst (ABC) is a rare osteolytic lesion that is often associated with osseous disease such as fibrous dysplasia (FD).

CASE DESCRIPTION

A 66-year-old woman previously diagnosed with FD presented with suddenly reduced visual acuity. Computed tomography and magnetic resonance imaging revealed a large osteolytic lesion in the middle cranial fossa that had invaded the left orbit. Although its radiological findings were compatible with an ABC, rotational digital subtraction angiography revealed that this osteolytic lesion was a large middle meningeal artery (MMA) aneurysm. To release the compression force on the optic nerve and confirm the diagnosis, we performed endovascular embolization, followed by surgical removal of the lesion. Histologic examination revealed that the resected lesion met the requirements of a thrombosed aneurysm. No new neurologic deficits appeared after the surgery, and no symptomatic recurrence have been noted during the 6-month follow-up.

CONCLUSIONS

This is the first case report to show that ABC-like lesions in patients with FD could be thrombosed MMA aneurysms. It is thus possible that some lesions previously diagnosed as ABCs were thrombosed MMA aneurysms or included a thrombosed MMA aneurysm. It is therefore important to rule out the presence of a MMA aneurysm when we encounter what appears to be an ABC in the presence of FD.

Posttraumatic Middle Meningeal Artery Pseudoaneurysm: Case Report and Review of the Literature

BACKGROUND

Intracranial pseudoaneurysm is a rare entity, with few cases described in the literature, and is mostly associated with a history of traumatic brain injury. Traumatic aneurysms comprise <1% of all intracranial aneurysms. In particular, middle meningeal artery (MMA) aneurysms are uncommon and usually caused by a skull fracture in the temporal region. About 40 traumatic MMA aneurysms are reported in the literature, and only 28 nontraumatic aneurysms are reported, usually related to high-flow conditions. The behavior of these aneurysms is largely unknown: both spontaneous resolution and aneurysm growth, leading to subsequent rupture, have been reported. Surgical and endovascular management are feasible for MMA aneurysms; however, the criterion standard treatment is not defined.

CASE DESCRIPTION

We report the case of a traumatic pseudoaneurysm of the right MMA treated with an endovascular approach and provide a review of the literature.

CONCLUSIONS

Aneurysms of the MMA are a rare entity that must be taken into account in the setting of a traumatic brain injury or predisposing factors. The diagnosis and aggressive treatment are mandatory, preventing the devastating consequences of their rupture. Endovascular and surgical techniques are well defined and available, even though there is not a demonstrated superiority in any of them.

Mycotic Pseudoaneurysm Associated with Skull Base Osteomyelitis Treated with Endovascular Embolization

Pseudoaneurysms occur due to malformations in arterial wall uniformity, leading to blood collection between the outer arterial layers and resultant outpouching of the vessel. Unlike true aneurysms, pseudoaneurysms do not involve all layers of the blood vessel. Mycotic pseudoaneurysms can occur after associated vessel adventitia infection, leading to transmural dissection. Here we present a case of a 78-year-old man with a history of chronic otitis externa and osteomyelitis who presented with increasing right ear pain with bloody discharge and associated headache. Catheter angiography demonstrated a large pseudoaneurysm in the right middle meningeal artery (MMA) at the base of the skull. Based on the clinical findings and the patient’s history, the patient was ultimately diagnosed with mycotic pseudoaneurysms of the MMA. The patient was subsequently treated with antibiotics as well as endovascular embolization and recovered without any complications.