Resection of sphenoid wing meningioma with blood pressure augmentation reverses acute symptomatic left middle cerebral artery syndrome: illustrative case.

backgroundMeningiomas are typically benign, slow-growing tumors, but in rare cases, they can also cause symptomatic compression of cerebral arteries, potentially leading to stroke. Historically, management of such cases often required supplementary revascularization procedures. This report reviews cerebral artery compression secondary to meningiomas and presents a case of a left sphenoid wing meningioma causing compression of the left middle cerebral artery (MCA) with resulting acute neurological deficits, which resolved after emergency tumor resection and blood pressure optimization. OBSERVATIONS: A 28-year-old female with a history of migraines presented with acute right hemiplegia, numbness, and dysarthria (National Institutes of Health Stroke Scale score 11). Imaging revealed a 4.5-cm dura-based mass in the left middle cranial fossa, displacing and compressing the left MCA, with early signs of infarction. An angiogram revealed limited treatment options, and she underwent an urgent left frontal craniotomy for tumor resection and neurovascular decompression. Pathological examination confirmed meningioma. Following surgery, she experienced near-complete recovery of motor and language function. LESSONS: Meningiomas are a rare cause of symptomatic MCA stenosis. While revascularization strategies have been described, surgical decompression can potentially provide rapid neurological improvement. Urgent tumor resection with medical optimization should be considered as an effective treatment strategy for symptomatic meningioma-induced cerebral artery stenosis. https://thejns.org/doi/10.3171/CASE2515.