Integrated Management Strategies for Concurrent Meningioma and Intracranial Aneurysm: Insights from a Systematic Review

Introduction: Concurrent Meningioma and Intracranial Aneurysm (IA) present diagnostic and therapeutic challenges. A definitive management strategy remains elusive despite recognition in the literature. The study aims to provide an updated systematic review addressing complexities in managing this complex dual pathology.

Methods: A systematic review across PubMed, Web of Science, and Embase databases was conducted. Through a comprehensive analysis of various treatment strategies and patient outcomes, a treatment framework was formulated based on the spatial relationship between the meningioma and IA, feasibility of concurrent management, aneurysm rupture risk, and patient symptoms.

Results: Seventy articles involving 121 patients were analyzed. Patients, predominantly female (80%) with a mean age of 55 (± 13.1), presented primarily with headaches (36%) and visual impairment (27%). 82% of meningiomas were in the frontotemporal and sellar areas, corresponding to 92% of IA in the anterior circulation. 86% of IA were detected incidentally during pre-operative examination of meningiomas, a total of 14% were ruptured. Management strategies varied based on the feasibility of simultaneous management and IA rupture status. In cases where both pathologies could be managed via the same approach, single craniotomy was performed in 39%. Considerations of whether the IA originated from a meningioma external carotid artery feeding artery informed the treatment sequence, favoring endovascular management (73%). For cases treated with tumor resection only, 26% were associated with post-operative IA rupture (range 0-30 days post-op). Hence, it is advisable to prioritize IA management before or concurrently with meningioma treatment.

Conclusion : This study proposes a comprehensive treatment algorithm aimed at guiding neurosurgeons in the management of concurrent meningioma and IA cases, addressing the intricacies of individual patient scenarios.