Inadvertent Compromise of the thalamogeniculate artery during surgery for invasive tentorial notch Meningioma: A case report

• Tentorial notch meningiomas have aggressive behaviors and could have vascular encasement and attachments. • Small vascular attachments to the tumor capsule could remain invisible on routine imaging. • Advance techniques and equipment are advisable for selected case. • Surgeons should be aware of complications and be prepared. Meningiomas, usually benign brain tumors, occasionally exhibit aggressive behavior, as seen in tentorial notch meningiomas (TNMs). We detail a case of a 63-year-old woman with a TNM tightly adhered to vascular structures. Surgical resection led to inadvertent damage to the thalamogeniculate artery branch of posterior cerebral artery, leading to deep brain ischemia likely during clipping of basilar trunk. TNMs, comprising about 5% of meningiomas, present challenges due to their deep-seated location and intricate vasculature. Surgical planning must foresee potential vascular adhesions, and advanced angiography could aid in their identification. This case underscores the need for comprehensive understanding of cerebrovascular anatomy, emphasizing tailored surgical approaches and preparedness for managing vascular complications.