Related Experiment Video
Updated: Jun 7, 2025
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Coil Embolization of a Ruptured Traumatic Pseudoaneurysm of the Middle Meningeal Artery: A Case Report
Naoki Nishizawa1, Tomoki Kidani1, Shin Nakajima1
1Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan.
Abstract:
Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare and have a poor prognosis due to their high risk of rupture. This study presents a case of a 53-year-old man who experienced rupture of an MMA pseudoaneurysm 10 days after craniotomy for an acute subdural hematoma caused by a blunt head injury. He also had an accompanying temporal bone fracture extending to the skull base. Initial imaging showed no evidence of cerebrovascular injury. The rupture resulted in a temporal hemorrhage with intraventricular extension that caused acute hydrocephalus. Digital subtraction angiography showed that the pseudoaneurysm was located just below the right temporal bone fracture. Coil embolization of the aneurysm was performed and complete occlusion was achieved. His hydrocephalus was addressed with placement of an external ventricular drain, which was later converted to a ventriculoperitoneal shunt. There was no rebleeding and he was transferred to a convalescent hospital. Traumatic MMA pseudoaneurysms usually develop several days after injury and are thus not present on imaging immediately after injury. Aggressive treatment is warranted due to their poor prognosis.
Insights
Traumatic middle meningeal artery pseudoaneurysms are rare but dangerous. Prompt diagnosis and treatment, like coil embolization, are crucial for managing rupture and preventing poor outcomes.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are uncommon vascular lesions with a high risk of rupture and poor prognosis.
- Blunt head trauma can lead to MMA pseudoaneurysms, often presenting days after the initial injury, complicating early diagnosis.
Observation:
- A 53-year-old male developed a ruptured MMA pseudoaneurysm 10 days post-craniotomy for an acute subdural hematoma secondary to blunt head injury.
- The patient presented with a temporal hemorrhage and intraventricular extension causing acute hydrocephalus, with a temporal bone fracture noted.
- Initial imaging did not reveal cerebrovascular injury, highlighting the delayed presentation of traumatic MMA pseudoaneurysms.
Findings:
- Digital subtraction angiography identified the pseudoaneurysm adjacent to the temporal bone fracture.
- Successful coil embolization achieved complete occlusion of the MMA pseudoaneurysm.
- Management of hydrocephalus involved an external ventricular drain followed by a ventriculoperitoneal shunt.
Implications:
- This case underscores the importance of considering delayed MMA pseudoaneurysm formation after head trauma and neurosurgical procedures.
- Aggressive endovascular treatment, such as coil embolization, is effective in managing ruptured MMA pseudoaneurysms.
- Timely intervention is critical to improve patient outcomes and prevent catastrophic rebleeding.
