Abstract
BACKGROUND: Deep Sylvian meningiomas are rare and difficult to diagnose when small tumours lead to various symptoms. The difficulty associated with surgery is underestimated. Our case involved a mass (11 mm × 12 mm × 12 mm in size) in the right Sylvian fissure. It is the smallest deep Sylvian meningioma known and might be more easily misdiagnosed than previous examples. CASE SUMMARY: A well-enhanced mass in the right Sylvian fissure of a 26-year-old male with a three-month history of seizure was identified via magnetic resonance imaging. The patient underwent operations twice for seizure control. During the first operation, the tumour was surrounded by the second segment of the middle cerebral artery and its numerous perforators. Partial resection had to be selected due to mild arterial damage. After the first operation, the patient presented with simple partial seizure. During reoperation, we isolated the anatomical structure near the tumour and the tumour over and removed it from its dorsal side by piecemeal resection. CONCLUSION: This case reported the smallest deep Sylvian meningioma according to a literature review. Preoperative diagnosis is a crucial step due to deep Sylvian meningioma firmly adhering to the middle cerebral artery and its perforators. Adequate preparation is crucial to ensure the success of surgery.