Paleopathology of Endocranial Lesions: A Possible Case of a Middle Meningeal Artery Aneurysm in an Etruscan Child from Pontecagnano (Southern Italy)

Abstract

A middle meningeal artery (MMA) aneurysm is a type of intracranial aneurysm that has been rarely documented and is not completely understood in clinical medicine and especially in pediatrics, because juvenile cases have been extremely uncommon. Vascular conditions have occasionally been diagnosed in osteoarchaeological remains, providing evidence of their occurrence in previous eras. In the present report, we have described a lesion that was highly consistent with a case of an MMA aneurysm observed in an Etruscan child, whose remains had been exhumed during archaeological excavations in the necropolis of Pontecagnano (Salerno, southern Italy). The remains date back to the seventh to sixth century BC. Macroscopic and radiological examinations revealed an oval depression in the endocranial area corresponding to the parietal branch of the right MMA. The localized thinning of the bone and the absence of a bone reaction were compatible with a long-lasting compression of vascular origin highly consistent with an MMA aneurysm. Primary malignant bone tumors, bone metastasis, benign neoplastic conditions, and other non-neoplastic conditions, including calvarial venous malformations, eosinophilic granuloma, and sarcoidosis, could be excluded from the differential diagnosis, although the occurrence of other pathologies, such as dural arteriovenous fistulas, could not be rejected. Although it was not possible to definitely establish whether the MMA aneurysm was symptomatic, it could not be ruled out that rupture and subsequent extradural hemorrhage and/or intracranial hemorrhage could have caused the death of the child. From a paleopathological viewpoint, the case illustrated provides an interesting historical perspective on a rare neurovascular disorder that continues to be debated in modern clinical research.