Traumatic aneurysm of the middle meningeal artery presenting with traumatic middle meningeal arteriovenous fistula: a case report

Abstract

Objective: Traumatic arteriovenous fistula (AVF) concomitant with pesudoaneurysm involving the middle meningeal artery is uncommon. Traumatic AVF is also known to occasionally show spontaneous closure. We report a rare case of traumatic pseudoaneurysm of the middle meningeal artery identified after spontaneous closure of a traumatic AVF. Case presentation: A 36-year-old right-handed man suffered a head injury after falling from a step at home, and was brought to our institute. The patient showed no neurological deficits. Computed tomography (CT) showed no intracranial hemorrhage and he was discharged to home. Six days later, he consulted our outpatient clinic because of dizziness and pulsatile tinnitus on the right side. Fracture in the right temporal bone was found on review of the initial CT. Magnetic resonance (MR) imaging showed cerebral contusion in the left temporal lobe and MR angiography demonstrated AVF involving the middle meningeal artery. Angiography revealed direct AVF supplied by the dilated right middle meningeal artery and draining into the cavernous sinus with no cortical venous reflux. Transarterial embolization was attempted 56 days after head injury. Right external carotid artery angiography revealed spontaneous obstruction of the AVF. Selective middle meningeal artery angiography disclosed a small aneurysm, which was embolized completely by coils and glue material. Conclusion: It may be sometimes difficult to detect a traumatic pseudoaneurysm associated with a traumatic arteriovenous fistula of the middle meningeal artery. Close radiographical follow-up is necessary in this lesion.• Key words • traumatic arteriovenous fistula, pseudoaneurysm, spontaneous closure, middle meningeal artery 652-0803 9-2-6

A Case of Iatrogenic Middle Meningeal Arteriovenous Fistula That Occurred during Embolization of a Feeding Artery of Dural Arteriovenous Fistula

“…For embolization, the use of embolic agents such as Onyx and Embosphere (Merit Medical, South Jordan, UT, USA) has been reported 12) in addition to NBCA, 9) which was used in our patient. According to the above report, Almefty et al 4) achieved cure in eight of nine patients with MMAVF by embolization using Onyx.…”

Traumatic arteriovenous fistula of the middle meningeal artery treated with selective coil embolization: A case report

“…[ 2 ] Most cases were associated with skull fractures, seven with epidural or subdural hematomas, three with multiple drainages from the MMV, and one with an MMA-to-MMV shunt [ Table 1 ]. [ 1 , 2 , 6 , 9 , 10 , 12 ] Among the patients who underwent endovascular treatment, coil embolization alone was performed only for the patients included in the present study. Coils and liquid embolic material were used in the remaining cases.…”

Idiopathic Middle Meningeal Arteriovenous Fistula Associated with Segmental Arterial Mediolysis: A Case Report

“…MMAVF is a relatively rare disease, with typically post-traumatic or iatrogenic origins, [1][2][3][4][5][6] but rare idiopathic cases have also been reported. 2,4) A previous report has shown that most cases of traumatic MMAVF occurred due to a tear in the artery wall caused by a skull fracture.…”

“…However, rare cases with an idiopathic origin have also been reported. [1][2][3][4][5][6] MMAVF is suspected based on symptoms, such as tinnitus, bruit, exophthalmos, and findings of dilated vessels on MRI, and is diagnosed using DSA. 5,6) Segmental arterial mediolysis (SAM) is a rare vasculopathy characterized by an unusual noninflammatory and nonatherosclerotic disorder of the arterial medial layer.…”

“…[1][2][3][4][5][6] MMAVF is suspected based on symptoms, such as tinnitus, bruit, exophthalmos, and findings of dilated vessels on MRI, and is diagnosed using DSA. 5,6) Segmental arterial mediolysis (SAM) is a rare vasculopathy characterized by an unusual noninflammatory and nonatherosclerotic disorder of the arterial medial layer. [7][8][9] SAM usually affects the abdominal visceral arteries and forms aneurysms, but any vessel may be involved, including those in the head and neck region.…”