Coexistence of a laterally projecting C3 carotid aneurysm and a parasellar meningioma.

The coexistence of a symptomatic parasellar meningioma and an unruptured laterally projecting C3 carotid aneurysm in a 54 year old female is presented. Although the exact location of the aneurysm in relation to the distal doral ring could not be determined by preoperative neuroradiological studies, a surgical repair of the aneurysm was indicated since both the aneurysm and the meningioma could be exposed in the same operative field. All of the meningioma except for its dural attachment in the carotid cave was removed. Great care taken when drilling the anterior clinoid process as it had been croded by the aneurysm from below. The dural ring was tightly adherent to the neck of the aneurysm and had to be dissected sharply with a pair of microscissors. A prophylactic high flow EG-M2 radial arterial bypass graft was used to decrease the risk of stroke in this patient who had poor collateral circulation through the anterior and posterior communicating arteries. The aneurysm was clipped successfully and the patient was discharged without new neurological deficits. Surgical indications and operative technique are discussed.