Paleopathology of Endocranial Lesions: A Possible Case of a Middle Meningeal Artery Aneurysm in an Etruscan Child from Pontecagnano (Southern Italy)

Middle meningeal artery (MMA) aneurysm is a type of intracranial aneurysm that is rarely documented and not completely understood in clinical medicine and especially in pediatrics, as juvenile cases are extremely uncommon. A diagnosis of vascular conditions in osteoarchaeological remains can occasionally be made, providing evidence of their occurrence in past times. This paper describes a lesion highly consistent with a case of MMA aneurysm observed in an Etruscan child, whose remains were brought to light during archaeological excavations in the necropolis of Pontecagnano (Salerno, southern Italy) and date back to the 7-6 century BC. Macroscopic and radiological examination revealed an oval depression in the endocranial area corresponding to the parietal branch of the right MMA. The localized thinning of the bone and the absence of bone reaction are compatible with a long-lasting compression of vascular origin highly consistent with a MMA aneurysm. Primary malignant bone tumors, bone metastasis, benign neoplastic conditions, and other non-neoplastic conditions, including calvarial venous malformations, eosinophilic granuloma, and sarcoidosis, can be excluded from the differential diagnosis, although a concomitance of other pathologies, such as dural arteriovenous fistulas, cannot be rejected. While it is not possible to definitely establish if the MMA aneurysm was symptomatic, it cannot be ruled out that rupture and subsequent extradural hemorrhage and/or intracranial hemorrhage may have caused the death of the child. From a paleopathological point of view, the case illustrated provides an interesting historical perspective on a rare neurovascular disorder that continues to be debated in modern clinical research.