Double Trouble – An Anterior Clinoidal Meningioma with a Concurrent Right MCA Aneurysm

Although meningiomas and cerebral aneurysms are common intracranial pathologies, their coexistence in one patient is rare. We present a case of right anterior clinoid meningioma that has a concurrent right middle cerebral artery (MCA) aneurysm. A 55-year-old female complaining of right-sided visual loss was admitted to our department after magnetic resonance imaging (MRI) revealed a right anterior clinoid meningioma that was extending to sella turcica and expanded superiorly, compressing the optic chiasm. With a plan of transnasal transsphenoidal endoscopic excision, a preoperative computed tomography angiogram was obtained, per our protocol. This revealed an incidental 3 mm right MCA bifurcation aneurysm. Due to the possibility of postoperative aneurysm bleeding, the patient was operated on with a right-sided pterional craniotomy. After 5 days of postoperative follow-up, the patient was discharged without complications. The histopathological analysis confirmed the diagnosis of psammomatous meningioma. This case underlines the importance of preoperative planning and being vigilant for incidental findings that might cause fatal consequences.