The coexistence of an intracranial aneurysm (IA) and meningioma (MNG) is a rare clinical entity (0.13-1.17%). However, the prevalence of clinically occult MNGs may be underestimated, as routine vascular imaging often misses small lesions. We present two female patients with a history of multiple or recurrent IAs and prior endovascular treatment. During surgical clipping via a pterional approach, suspicious dural lesions-hypervascularization and thickening around the anterior clinoid process-were incidentally identified, despite being invisible on preoperative imaging. Intraoperative biopsies confirmed these lesions as MNGs. While the exact pathogenesis or underlying association remains speculative, these cases highlight the critical importance of unexpected intraoperative findings. Neurosurgeons must maintain high vigilance and strongly consider active biopsy of abnormal dura mater encountered during IA clipping, particularly in patients with multiple IAs or previous endovascular treatments.
Ko et al. (Thu,) studied this question.