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Follow-up angiogram obtained six months post-head injury indicating no signs of recurrence of the pseudoaneurysm.
Source publication
Traumatic pseudoaneurysm of the middle meningeal artery (MMA) is a rare entity that is typically associated with a high risk of rupture and mortality. Only few such cases of pseudoaneurysms have been reported in the medical literature and therefore, the optimal management of this condition remains undetermined. The present study reported on a femal...
Context in source publication
Context 1
... that the hyperdense nodule, which was present pre-operatively, had disappeared and there were no signs of any new hemorrhage. The patient was discharged from hospital on the third post-operative day with no neurological deficit. Follow-up DSA performed six months following the head injury revealed no signs of recurrence of the pseudoaneurysm (Fig. ...
Similar publications
Pseudoaneurysms of the middle meningeal artery are rare events following head trauma. Given the potential for significant morbidity and mortality associated with pseudoaneurysm rupture, it is recommended that they be treated early. Endovascular embolization is a viable alternative to open surgical intervention. Here, we describe a case of an incide...
Citations
... Early CT findings suggestive of an MMA pseudoaneurysm include the presence of a basilar skull fracture in the temporal region, a hypodense nodule within an acute hematoma, and strong and homogenous enhancement of the hypodense nodule within an organized hematoma [15]. DSA, however, is considered the gold standard imaging modality for diagnosis and may demonstrate an elliptical or irregular aneurysmal sac without a neck, a peripheral location of the pseudoaneurysm at a distance from a branching point and delayed slow filling and emptying of contrast [10,16]. ...
... Surgical management consists of MMA ligation, coagulation, and resection [4,17]. Surgical intervention can be considered in cases with significant epidural hematoma as it allows for simultaneous evacuation, but is associated with a greater risk of intraoperative pseudoaneurysm rupture [16,18,19]. As such, endovascular embolization is considered first-line treatment of pseudoaneurysms in the absence of significant mass effect [14,19]. ...
... As such, endovascular embolization is considered first-line treatment of pseudoaneurysms in the absence of significant mass effect [14,19]. Modalities can include liquid embolic agents such as Onyx [12,16] or N-butyl cyanoacrylate [6,11,13] as well as endovascular coiling [2,3,5,14,17,20]. A long-term follow-up is not well characterized with regard to the risk of recurrence or recanalization, thus no specific method of embolization can be recommended at this time. ...
Pseudoaneurysms of the middle meningeal artery are rare events following head trauma. Given the potential for significant morbidity and mortality associated with pseudoaneurysm rupture, it is recommended that they be treated early. Endovascular embolization is a viable alternative to open surgical intervention. Here, we describe a case of an incidentally found middle meningeal artery pseudoaneurysm in a patient with a carotid-cavernous fistula after head injury. The pseudoaneurysm was treated with endovascular coil embolization.
... In 1990, Taki et al. developed an EVA-based embolic agent which was clinically applied in three cases of AVM embolization successfully [16]. Since then, Onyx ® has been used successfully for the treatment of cerebral AVMs [125][126][127][128], peripheral AVMs [129][130][131][132], AVFs [11,12,17,133,134], intracranial aneurysms [22,24,135,136], renal artery aneurysm [1,140], bleeding from ruptured aneurysms [138,139], endoleaks [25,[140][141][142][143][144][145][146][147][148][149][150], and preoperative embolization [18,19,25,[151][152][153]. ...
... Using this treatment, immediate occlusion of the aneurysm was achieved, and the parent artery was spared from sacrifice. In 2019, Lu et al. reported the successful embolization of a traumatic pseudoaneurysm of the middle meningeal artery using Onyx in one patient [136]. ...
Endovascular embolization (EE) has been used for the treatment of blood vessel abnormalities, including aneurysms, AVMs, tumors, etc. The aim of this process is to occlude the affected vessel using biocompatible embolic agents. Two types of embolic agents, solid and liquid, are used for endovascular embolization. Liquid embolic agents are usually injectable and delivered into the vascular malformation sites using a catheter guided by X-ray imaging (i.e., angiography). After injection, the liquid embolic agent transforms into a solid implant in situ based on a variety of mechanisms, including polymerization, precipitation, and cross-linking, through ionic or thermal process. Until now, several polymers have been designed successfully for the development of liquid embolic agents. Both natural and synthetic polymers have been used for this purpose. In this review, we discuss embolization procedures with liquid embolic agents in different clinical applications, as well as in pre-clinical research studies.
... Both CTA and DSA have comparable accuracy in the detection of small intracranial aneurysms [15][16][17]. For MMAPs specifically, in a small prospective study by Paiva et al of 11 patients with epidural hematomas, both CTA and DSA detected 3 MMAPs in this group [18]. ...
Patient: Male, 42-year-old
Final Diagnosis: Middle meningeal artery pseudoaneurysm
Symptoms: Migraine
Medication:—
Clinical Procedure: —
Specialty: Radiology
Objective
Unusual clinical course
Background
Middle meningeal artery (MMA) aneurysms are a very rare entity, comprising less than 1% of all intracranial aneurysms. In particular, traumatic MMA pseudoaneurysms (MMAP) are reported in the literature to have a poor outcome in about 20% of cases. Moreover, in extremely rare cases, MMAPs can spontaneously thrombose.
Case Report
We present the case of a 42-year-old Hispanic man with multiple craniofacial hemangiomas and history of chronic migraines that increased in frequency after blunt head trauma 1 month prior to initial evaluation. CTA and brain MRI showed a right-sided MMAP adjacent to the foramen spinosum with a pan-hemispheric subdural hematoma and no associated skull fractures. The MMAP was not visualized 2 days later on digital subtraction angiography (DSA) and was therefore presumed to be thrombosed. CTA at 3 months showed interval progression of the MMAP with subsequent spontaneous resolution on CTA at 10 months.
Conclusions
Knowledge regarding MMAPs is limited since it is based on a small number of cases and literature reviews. Additional studies are needed to elucidate the true incidence and natural course of this entity and produce adequate treatment guidelines.
A BSTRACT
Traumatic pseudoaneurysm of middle meningeal artery (MMA) occurs mostly in association with temporal bone fractures following head trauma. Hence, timely, the management of such pseudoaneurysm is extremely of crucial importance for improving prognosis. The article reports the case of a patient who met with a motor vehicle accident and was found to have a large intracerebral haematoma in the left temporal lobe on the initial non-contrast computed tomography scan of the brain, which on evaluation with magnetic resonance imaging, was found to be a pseudo-aneurysm of the middle meningeal artery, successfully embolised with the liquid, non-adhesive embolic agent Onyx. This pseudoaneurysm was successfully embolised with the liquid, non-adhesive embolic agent Onyx.
Purpose
To explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.
Methods
Eleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.
Results
Complete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5-2.0 years without recurrence of nosebleed and scalp lump.
Conclusion
For patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.
Aqueous solutions of polyvinyl methyl ether were investigated in order to test whether it is possible to utilize them as bases for embolic agents used to deliberately block blood vessels. This may be necessary in the course of treatment of vascular abnormalities, tumors, as well as during the preparation of patients for surgery. The right branch of the binodal curve for the binary system “polyvinyl methyl ether–water” was drawn using the cloud point method and the lower critical mixing temperature (35.5 °C) was calculated. Furthermore, the exact concentration of polyvinyl methyl ether in aqueous solutions at which phase transition occurs (given the temperature of 35.5 °C) was found to be 30 wt %. The viscosity–velocity curves for the 30% solution of polyvinyl methyl ether, obtained by rheoviscometry in the temperature range of 5 to 36 °C, indicate that this aqueous solution has a low viscosity and behaves like a Newtonian fluid. However, at the temperature of 35 °C and higher, close to the phase transition, a significant deviation from its Newtonian behavior is observed due to precipitation of polyvinyl methyl ether as it forms a solid white mass. Through the use of the Arrhenius–Frenkel–Eyring equation, the activation energy of the viscous flow for polyvinyl methyl ether solutions was found to be 31 kJ/mol. Based on refractometry data, it was demonstrated that phase transition in aqueous solutions of polyvinyl methyl ether is reversible. This feature can facilitate medical equipment cleaning before introducing the embolic agent into a patient’s bloodstream. Finally, the investigation determined some parameters, in which the formation of embolic agents from a 30% polyvinyl methyl ether aqueous solution occurs (in situ in a blood vessel at a temperature of 35.5 °C).
