Postcraniotomy superficial temporal artery pseudoaneurysm in the setting of triple H therapy: A case report and literature review

Abstract

Background:Superficial temporal artery (STA) pseudoaneurysm after a craniotomy is very rare with only five cases reported in the literature, none manifesting in the setting of cerebral vasospasm treatment with triple H therapy.Case Description:A 31-year-old male was admitted after a syncopal episode. Imaging documented a ruptured anterior communicating artery aneurysm. He was taken to the operating room for aneurysm clipping, but the procedure was aborted due to intraoperative aneurysm re-rupture, at which point the patient underwent emergent coil embolization of the aneurysm. The postoperative course was complicated by severe cerebral vasospasm requiring prolonged triple H therapy. On postoperative day 22, a growing left temporal mass with a bruit was noted. The suspected diagnosis of STA pseudoaneurysm was confirmed by femoral angiography, and it was treated with coils and Onyx embolization.Conclusion:We report the first case of a postcraniotomy STA pseudoaneurysm in the setting of induced hypertension for the treatment of cerebral vasospasm. Endovascular embolization is a viable option for the treatment of an STA pseudoaneurysm.

Superficial temporal artery pseudoaneurysm presenting as extradural hematoma: A case report and review of literature

“…In reviewing the literature, we found reports of only nine cases of postcraniotomy STA pseudoaneurysms. [ 4 5 6 7 8 9 10 11 12 ] The age at presentation ranged from 17 to 73 years. Six of the cases were males, two were females and the gender of one case was not specified.…”

“…Six of the cases were males, two were females and the gender of one case was not specified. Five of the cases presented with aneurysmal subarachnoid hemorrhage that underwent surgical clipping,[ 9 10 ] one underwent bilateral frontal sinus reconstruction,[ 6 ] one had a frontal meningioma resected, one following posttraumatic intracerebral hematoma[ 13 ] and another following ventriculostomy. [ 11 ] The STA pseudoaneurysm presentation was delayed in all cases, ranging from 17 days to 3 months.…”

“…One of the five cases was initially misdiagnosed as fluid or infectious collection and accessed percutaneously with a needle, yielding brisk arterial flow. Six cases were treated surgically,[ 9 10 ] two endovascular[ 7 13 ] and one was treated with percutaneous injection of thrombin glue. [ 4 ]…”

“…The aneurysm in this case is probably a traumatic cause and not vasculitis induced, as there is no evidence of it in the histopathological examination. Furthermore, an underlying arterial wall predisposition has been noted in two thirds of the described cases of STA pseudoaneurysm in the setting of ruptured intracranial aneurysms[ 9 10 ] while such reports have not been made in similar craniotomies used for tumor resection or other nonvascular procedures. Though the surgery around the STA is regularly done in neursourgery, the development of pseudoaneurysms in very rare cases raises suspicion about any underlying secondary pathology of the vessel wall per se .…”

“…STA pseudoaneurysm after a craniotomy is very rare with only nine cases reported in the literature. [ 4 5 6 7 8 9 10 11 12 ] We report the first case of a postcraniotomy STA pseudoaneurysm presenting as EDH following craniotomy for intracranial tuberculoma.…”