Myonecrosis of the middle cerebral artery with thrombosis and cerebral infarction following resection of meningioma

The authors report the clinical, radiological and pathological findings in a case of myonecrosis of the right middle cerebral artery following resection of a right temporal lobe meningioma. Postoperatively, the 64 yr old female patient developed a left hemiplegia and died with a massive pulmonary embolus on the eighth day. At postmortem examination the right middle cerebral artery showed recent necrosis of the wall in the area of previous surgery, with thrombosis of the artery and a large right parietal lobe cerebral infarct. Although myonecrosis of arteries has been described in a variety of settings, we know of no previous reported case following a routine neurosurgical procedure. We propose a dual pathogenesis of vasospasm plus damage to the external layers of the arterial wall at surgery and discuss the possible mechanisms based on a review of the literature.