Middle meningeal artery aneurysm: a possible case in a child from the Etruscan site of Pontecagnano

A middle meningeal artery (MMA) aneurysm is a variety of intracranial aneurysm that is not completely understood in clinical medicine and has been rarely documented especially in pediatrics, since juvenile cases are particularly infrequent. Vascular disorders have occasionally been identified in osteoarchaeological remains, confirming their occurrence in past times. The present report illustrates a lesion that is highly consistent with a case of an MMA aneurysm detected in a child, brought to light during the archaeo- logical excavations in the Etruscan site of Pontecagnano (Salerno, southern Italy) and dated back to the 7th to 6th century BC. Macroscopic examination and radiological analysis revealed an oval depression in the endocranial region corresponding to the parietal branch of the right MMA. The absence of a bone reaction and the localized thinning of the bone were consistent with a long-lasting compression of vascular origin compatible with an MMA aneurysm. The differential diagnosis rejected benign neoplastic conditions, primary malignant bone tumors, bone metastasis among other non-neoplastic conditions, such as eosinophilic granuloma, sarcoidosis, and calvarial venous malformations, despite the occurrence of other disorders, including dural arteriovenous fistulas, could not be ruled out. It could not be excluded that extradural hemorrhage and/or intracranial hemorrhage subsequent rupture could have caused the death of the child, though it was not possible to confirm whether the MMA aneurysm was symptomatic. From a paleopathological standpoint, the case described offers a compelling historical perspective on an uncommon neurovascular disease that continues to be discussed in modern clinical research.