Pseudoaneurysm of the superficial temporal artery following revision of a middle cerebral artery aneurysm clipping: case report and review of the literature.

Abstract

Pseudoaneurysms of the superficial temporal artery are mostly traumatic in origin. Here, a case of a superficial temporal artery aneurysm that emerged following a recraniotomy is presented. A 59-year-old woman was admitted with subarachnoid hemorrhage. She underwent a pterional craniotomy and clipping of a saccular aneurysm of middle cerebral artery bifurcation. A control digital subtraction angiography on the 3rd postoperative day revealed partial filling of the aneurysm and a revision was performed. The second control digital subtraction angiography on the 4th postoperative day of the revision showed a pseudoaneurysm of the left superficial temporal artery. The pseudoaneurysm was excised successfully under local anesthesia. In conclusion, pseudoaneurysm of the superficial temporal artery should be considered among the early postoperative complications of the surgical procedures at the superficial temporal artery territory. Although some conservative approaches are used, excision of the aneurysm is recommended for treatment.KeywOrds: Aneurysm, Craniotomy, DSA, Pseudoaneurysm, Superficial temporal artery ÖZYüzeysel temporal arter yalancı anevrizmaları çoğunlukla travması sonrası oluşurlar. Bu yazıda yinelenen kranyotomi sonrasında ortaya çıkan bir yüzeysel temporal arter yalancı anevrizması sunulmaktadır. 59 yaşındaki kadın hasta subaraknoidal kanama sebebiyle getirildi. Pteriyonel kranyotomi ile orta serebral arter bifurkasyon anevrizması kliplenmesi ameliyatı yapıldı. Postoperatif üçüncü günde yapılan kontrol dijital anjiyografi anevrizmada kısmi dolum kusuru gösterdiği için klip düzeltme ameliyatı yapıldı. Düzeltme ameliyatından sonraki 4. günde yapılan ikinci dijital anjiyografi incelemesinde sol yüzeysel temporal arterde bir adet yalancı anevrizma olduğu görüldü. Bu yalancı anevrizma lokal anestezi ile eksize edildi. Sonuçta, yüzeysel temporal arter bölgesindeki cerrahi girişimlerin erken komplikasyonlar arasında yalancı anevrizmaları da düşünmek gerekir. Yalancı anevrizmaların tedavisinde tutucu yöntemler kullanılsa da, tedavi için cerrahi çıkarım önerilmektedir.

Ruptured pseudoaneurysm of the superficial temporal artery after craniotomy

“…A pre-existing arterial wall abnormality might be another contributing factor. [3,6] Post-operative acute subcutaneous hematoma formation may indicate pseudoaneurysm formation as in this patient. [4,5] In this case, partial thrombosis might be responsible for absence of pulsations or bruit and also headache.…”

“…Sir, Pseudoaneurysm of the superficial temporal artery (STA) after craniotomy is extremely rare [1][2][3][4][5][6][7][8] and they seldom rupture. [2] A 57-year-old man was brought with sudden onset loss of consciousness.…”

“…[3,6] in most reported cases the lesions were pulsatile and expanding and non-presented with bleeding [1,2] and in none the bleeding was life-threatening disrupting an already sutured skin incision. [3,6] in most reported cases the lesions were pulsatile and expanding and non-presented with bleeding [1,2] and in none the bleeding was life-threatening disrupting an already sutured skin incision.…”

“…The most plausible cause for formation of pseudoaneurysm is trauma to the STA by skin incision, a pin head-holder, thread removal and subcutaneous drains. [3,5,6] Differential diagnoses for STA pseudoaneurysm include vascular tumor, arteriovenous fistula, meningeal artery aneurysm with bony erosion, subcutaneous lipoma, abscess and localized hematoma. Terterov and colleagues have suggested that triple-H therapy might accelerate the formation of pseudoaneurysm.…”

“…[4,5] In this case, partial thrombosis might be responsible for absence of pulsations or bruit and also headache. [2][3][4]7,8] During hematoma evacuation, we paid close attention to preventing anesthesia-induced hypotension and hence that there is no risk of worsening of symptomatic vasospasm. [2] In that patient, the aneurysm was at the outside of a skin flap, thus preventing subcutaneous hemorrhage.…”