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Case Reports
. 2014 May-Jun;20(3):352-6.
doi: 10.15274/INR-2014-10025. Epub 2014 Jun 17.

Traumatic pseudoaneurysm of the middle meningeal artery with an arteriovenous fistula on a non-fractured site

Jung Ho Ko  1 , Young-Joon Kim  2
Affiliations
Case Reports

Traumatic pseudoaneurysm of the middle meningeal artery with an arteriovenous fistula on a non-fractured site

Jung Ho Ko et al. Interv Neuroradiol. 2014 May-Jun.

Abstract

We describe a rare case of a combined traumatic pseudoaneurysm and arteriovenous fistula (AVF) of the middle meningeal artery (MMA) on a non-fractured site. A 24-year-old man was admitted to our hospital with head trauma. He underwent a craniotomy and removal of an epidural hematoma on the right side. Twenty-five days later, he complained of pulsatile tinnitus on the left non-fractured side. Angiography revealed a markedly dilated proximal MMA with flow shunting to the pterygoid plexus. We performed proximal occlusion on the proximal MMA for the traumatic pseudoaneurysm and the AVF of the MMA using coils. Although immediate angiography showed retrograde contrast filling from the collateral vessels into the distal part of the pseudoaneurysm, follow-up angiography revealed that the lesion had successfully disappeared.

Keywords: arteriovenous fistula; head trauma; middle meningeal artery; pseudoaneurysm.

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Figures

Figure 1
Figure 1
A,B) Brain computed tomography (CT) showed an epidural hematoma (EDH) combined with a skull fracture in the right temporoparietal area. C) Urgent craniotomy with removal of the hematoma was performed. The hematoma was completely removed.
Figure 2
Figure 2
A) Brain magnetic resonance angiography (MRA) revealed an abnormal vascular lesion on the left external carotid artery (ECA) (white arrow). B) A left external carotid angiogram showed the markedly dilated proximal MMA (arrowhead) with flow shunting to the pterygoid plexus (black arrow).
Figure 3
Figure 3
A) After the eighth and final coil was deployed, the immediate post-operation angiogram showed complete occlusion of the fistula. B,C) However, there was scant retrograde contrast filling into the distal part of the pseudoaneurysm from the collateral meningeal arteries (arrowhead).
Figure 4
Figure 4
A follow-up angiogram was obtained in the third month post-embolization. A complete disappearance of the pseudoaneurysm was revealed until the late venous phase of the ECA angiogram.
See this image and copyright information in PMC

References

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