Meningeal artery aneurysms are a rare but clinically significant pathology with high rupture rates and significantly worse outcomes for ruptured versus non-ruptured aneurysms, for which a novel pathophysiology-based classification system and endovascular-predominant treatment approach are proposed.
A total of 144 cases of meningeal artery aneurysms were analyzed, comprising 44 non-traumatic and 100 traumatic cases.
A novel pathophysiology-based classification system for non-traumatic meningeal artery aneurysms was proposed, dividing them into sporadic, hemodynamic/flow-related, and genetic/dysplastic subtypes.
Rupture rates were high for both sporadic and hemodynamic non-traumatic subtypes, with subdural and intracerebral hemorrhages predominating.
Delayed rupture occurred in 26% of traumatic meningeal artery aneurysm cases, with a median latency of 14 days.
Endovascular techniques became the primary treatment modality, implemented in 72% of recent cases after 2002.
Outcomes were significantly worse for ruptured meningeal artery aneurysms compared to non-ruptured aneurysms.
Clinical recognition of meningeal aneurysm risk factors was identified as key to enabling targeted diagnostic evaluation and timely intervention.
This research examined aneurysms (abnormal bulges or weaknesses) occurring in the meningeal arteries — blood vessels that supply the membranes covering the brain — which are different from the more commonly known brain aneurysms. By reviewing 144 previously reported cases from the medical literature alongside 9 additional cases from the authors' own institution (mostly combat-related injuries), the researchers found that these aneurysms fall into two main groups: those caused by trauma (such as head injury) and those arising spontaneously or due to underlying conditions. For the non-traumatic group, they proposed a new classification based on what causes the aneurysm to form, including cases linked to tumors, abnormal blood vessel connections, or inherited conditions. The study found that these aneurysms carry a significant risk of rupture and bleeding into or around the brain. In spontaneous cases, nearly 4 in 5 aneurysms had ruptured by the time they were identified, and in trauma cases, about 1 in 4 ruptured after a delay of about two weeks following the original injury. This delayed rupture risk is particularly important because patients may appear to be recovering from their head injury before the aneurysm becomes dangerous. When rupture did occur, outcomes were much worse — 35% of patients with ruptured aneurysms had poor outcomes, compared to only 6% of those whose aneurysms were treated before rupture. This research suggests that meningeal artery aneurysms are an underrecognized but serious condition that can be mistaken for other causes of brain bleeding. The shift toward minimally invasive endovascular treatments (where instruments are guided through blood vessels rather than requiring open surgery) — used in 72% of cases after 2002 — appears to represent progress in management. The findings highlight the importance of awareness among clinicians, particularly following head trauma or in patients with conditions that increase blood flow demands on meningeal vessels, so that these aneurysms can be identified and treated before they rupture.
Stanishevskiy A, Babichev K, Svistov D, Savello A, Martynov R. (2026). Aneurysms of the meningeal arteries: systematic review and illustrative case series.. Neurosurgical review. https://doi.org/10.1007/s10143-026-04500-w