Andrea Boschi - MD, Resident in Neurosurgery, University of Florence, Florence, Italy
Giovanni Barbagli - MD, Resident in Neurosurgery, University of Florence, Florence, Italy
Bahman Ashraf-Noubari - MD, Consultant in Neurosurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Edvardo Cipolleschi - MD, Neurosurgery Clinic, University of Florence, Italy

Background & Importance: Our study was performed based on the first case, reported in English, of a patient with three contemporarylesions, an extra-axial malformation and two vascular ones.Case Presentation: A 62-year-old man referred to our clinic due to right hand tremor associated to a slowing of idea-forming functionand movements. The neuroradiological evidence showed a right fronto-temporal meningioma with the contemporary presence of anarteriovenous malformation (AVM) and of an aneurysm. The neuroradiological finding showed, also, a presumably flow-related rightcarotid-ophthalmic aneurysm with two millimeters in size. We performed the meningioma excision by the usage of cavitron ultrasonicsurgical aspirator (CUSA), after the isolation of the sylvian fissure with the microdoppler and the removal of the AVM by the Hashimototechnique. Considering the very small size of the aneurysm, we decided to leave it in site.Conclusion: The post-operative examination showed a complete removal of the lesions, meningioma and AVM. We performed anexhaustive review of the current literature, and the result encompassed only another case, written in Japanese, about the contemporarypresence of these three lesions.

Meningioma; Brain Arteriovenous Malformation; Brain Aneurysm; Association; Literature