A Rare Association between Meningioma and Two Intracranial Vascular Lesions: Case Report and Review of Literature

Background & Importance: Our study was performed based on the first case, reported in English, of a patient with three contemporary lesions, an extra-axial malformation and two vascular ones.
A 62-year-old man referred to our clinic due to right hand tremor associated to a slowing of idea-forming function and movements. The neuroradiological evidence showed a right fronto-temporal meningioma with the contemporary presence of an arteriovenous malformation (AVM) and of an aneurysm. The neuroradiological finding showed, also, a presumably “flow-related” right carotid-ophthalmic aneurysm with two millimeters in size. We performed the meningioma excision by the usage of cavitron ultrasonic surgical aspirator (CUSA), after the isolation of the sylvian fissure with the microdoppler and the removal of the AVM by the Hashimoto technique. Considering the very small size of the aneurysm, we decided to leave it in site.
The post-operative examination showed a complete removal of the lesions, meningioma and AVM. We performed an exhaustive review of the current literature, and the result encompassed only another case, written in Japanese, about the contemporary presence of these three lesions.