2026 Poster Presentations
P465: CRANIOTOMY FOR CONCURRENT ANTERIOR COMMUNICATING ARTERY ANEURYSM CLIPPING AND MIDDLE CRANIAL FOSSA TUMOR RESECTION: CASE REPORT AND SYSTEMATIC LITERATURE REVIEW
Jacob Cliett; Christopher J Carr; Matthew Lee; Miki Patel; Shannon Derthick; Muhammad Ali; Medical College of Georgia
Introduction: There are no clear guidelines for treatment of unruptured intracranial aneurysms in the setting of other concurrent intracranial pathologies like tumors. Staged endovascular aneurysm treatment followed by tumor resection and simultaneous open neurosurgical treatment of both pathologies have been proposed in the literature. Here we present a case of simultaneous anterior communicating artery (AcommA) aneurysm clipping and middle cranial fossa meningioma resection. We also conduct a systematic review of the literature to describe indications and outcomes related to concurrent surgical treatments for intracranial aneurysms (IAs) and tumors.
Methods: Two independent reviewers conducted a systematic review of the PubMed database following PRISMA guidelines for articles describing IAs and tumors that were both surgically treated during the same operation in order to characterize treatment decisions and outcomes for simultaneous surgical treatment of coexisting intracranial pathologies.
Results: A 46-year-old woman presented with a 3-week history of right eye swelling. Head imaging workup including CTA and MRI was concerning for a mass in the right middle cranial fossa extending into the right orbit and cavernous sinus, congenital absence of the left internal carotid artery, and a flow-induced AcommA aneurysm.
Given the patient’s intracranial mass and flow-induced anterior communicating artery aneurysm, she underwent right-sided pterional craniotomy for tumor resection and aneurysm clipping. The lateral wing of the sphenoid bone and superior and lateral walls of the orbit were drilled down for bony decompression. Drilling was continued into the middle cranial fossa until the superior orbital fissure and foramen rotundum were exposed. Once the extradural portion of the tumor was resected, a frontotemporal incision in the dura was made for continued resection. The tumor was debulked in the intradural portion of the middle cranial fossa in piecemeal fashion with a two-suction technique. Blunt dissection was used to identify the oculomotor nerve laterally and the ICA and optic nerve medially. After further tumor debulking, the AcommA aneurysm was clipped, and complete occlusion and proximal and distal flow were confirmed intraoperatively with doppler ultrasound. Our systematic review yielded a total of 22 reported cases of simultaneous intracranial aneurysm and tumor surgery across 20 articles. All reported cases had complete aneurysm occlusion, and no mass-lesion related symptoms reported after surgery. Surgical decision-making focused on anatomical proximity and prevention of future complications.
Conclusion: The association between intracranial aneurysms and intracranial tumors is not well understood, including if there is a connection between their occurrence or if they are unrelated. Similarly, treatment guidelines and outcomes for concurrent intracranial tumors and aneurysms are also poorly characterized in the literature. We present a case of a patient who initially presented for right orbital swelling caused by an ipsilateral meningioma and was found to have an AcommA aneurysm. Both pathologies were successfully treated simultaneously via right pterional craniotomy. A systematic review of the literature revealed 22 cases of successful concurrent tumor resection and open aneurysm treatment. Given safety, convenience, and cost-effectiveness considerations, open treatment of aneurysms may be indicated in the presence of an additional indication of craniotomy.