Treatment and outcomes of concomitant parasellar meningiomas and anterior circulation aneurysms: a systematic review and perspective in the endovascular era.

The coexistence of parasellar meningiomas and anterior circulation aneurysms is rare, and their anatomical proximity complicates diagnosis and treatment, making management challenging and risky. This study aims to assess the literature on the treatment strategies, clinical-surgical outcomes, and complications in such complex cases. We searched Pubmed, Embase, Scopus, and Web of Science databases following PRISMA guidelines for studies reporting clinical and/or surgical outcomes related to concomitant parasellar meningiomas and anterior circulation aneurysms. Thirteen case reports and one case series were included, involving a total of 14 patients aged between 46 and 81 years, with 33% male. Only five studies reported tumor histopathology, with four cases of transitional meningioma. Most aneurysms were ipsilateral (8 cases), while 3 were both ipsilateral and contralateral, and 3 were bilateral. The most common presenting symptoms were visual disturbances in 50% (n = 7) of cases and headaches in 42.85% (n = 6). The sequence of interventions varied among patients, with 78,5% (n = 11) undergoing simultaneous treatment for both lesions and 21,5% (n = 3) undergoing interventions at different times. Only six studies reported the follow-up duration, which ranged from 3 months to 5 years. Postoperative outcomes varied across studies. It was reported that nine patients had no neurological deficits following treatment. In one case, postoperative complications were reported, including bilateral anosmia and normal-pressure hydrocephalus following a bilateral frontal craniotomy. This systematic review highlights the complexity and rarity of managing concomitant parasellar meningiomas and anterior circulation aneurysms. Overall, the treatment of this association was safe and effective in the fourteen patients found in the literature. However, the available data is limited by a lack of comprehensive reporting on crucial information such as resection and long-term outcomes and comprises only case reports. This review contributes to the literature by synthesizing the available evidence and highlighting the role of endovascular approaches in treating those complex cases.