J Korean Neurosurg Soc.  2014 Nov;56(5):423-427. 10.3340/jkns.2014.56.5.423.

Angiographically Progressive Change of Traumatic Pseudoaneurysm Arising from the Middle Meningeal Artery

• Lee JY
• Lee CY
• Kim HW

• KMID: 2018102
• DOI: http://doi.org/10.3340/jkns.2014.56.5.423

Abstract

Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare phenomenon, which are usually associated with head trauma such as an underlying skull fracture. They were usually known to cause acute or delayed epidural hematomas but can be associated with subdural, subarachnoid, or even intracerebral hemorrhage. Sometimes, a high mortality rate was reported in these circumferences. But the natural course of these pseudoaneurysms is not well recognized. The indication and guideline of treatment for pseudoaneurysm are also unclear. This report describes a rare case of angiographically progressive change of traumatic pseudoaneurysm of the middle meningeal artery for one week, which was treated with endovascular embolization.

Keyword

Pseudoaneurysm; Middle meningeal artery

MeSH Terms

Aneurysm, False*
Cerebral Hemorrhage
Craniocerebral Trauma
Hematoma
Meningeal Arteries*
Mortality
Skull Fractures

Figure

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  Fig. 1 Initial brain computed tomography revealed a skull fracture, epidural hematoma in the right hemisphere and subarachnoid hemorrhage in both sylvian fissures and basal cistern.

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  Fig. 2 Computed tomography angiogram showed an aneurysm of right middle cerebral artery bifurcation (arrow).

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  Fig. 3 Cerebral angiogram showed two pseudoaneurysms arising from the posterior branch of right middle meningeal artery.

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  Fig. 4 After 1 week, cerebral angiogram was repeated. The angiogram showed that the one pseudoaneurysm changed more aggravating appearance. The initially found distal pseudoaneurysm is collapsed, and another aneurysm was found more aggravating appearance.

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  Fig. 5 After embolization, the posterior branch of the middle meningeal artery including pseudoaneurysm was no more visible.

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  Fig. 6 Initial brain computed tomography revealed a skull fracture, epidural hematoma in left temporal area.

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  Fig. 7 Computed tomography angiogram showed bilateral internal carotid artery stenosis.

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  Fig. 8 Cerebral angiogram showed pseudoaneurysm arising from the middle meningeal artery.

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  Fig. 9 After 1 week, repeated cerebral angiogram showed the pseudoaneurysm changed more aggravating appearance.

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  Fig. 10 After embolization, there is no filling of the pseudoaneurysm.

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