Traumatic Lesions of the Bilateral Middle Meningeal Arteries. Case Report.

Abstract

A 44-year-old man presented with traumatic injuries of the bilateral middle meningeal arteries after a traffic accident. Neurological examination found left visual impairement due to left optic nerve injury. Computed tomography demonstrated a small amount of left epidural hemorrhage and bilateral skull fractures. Left external carotid angiography revealed a pseudoaneurysm of the left middle meningeal artery at the sphenoid ridge. Right external carotid angiography demonstrated a dural arteriovenous fistula fed by the right middle meningeal artery colocated with the right frontal convexity fracture. Transarterial embolization of the left middle meningeal artery pseudoaneurysm with four fibered platinum coils and transarterial embolization of the right dural arteriovenous fistula with poly(2-hydroxyethyl methacrylate-co-methyl methacrylate) were performed, resulting in complete obliteration of both lesions. Angiographic cure was obtained and the postoperative course was uneventful.

Traumatic Middle Meningeal Artery Pseudoaneurysms Presenting with Intractable Epistaxis: A Rare Case Report and Review of Literature

“…Pseudoaneurysms of the middle meningeal artery (MMA) are rare. About 70% -90% of cases of traumatic MMA pseudoaneurysms are associated with a fracture crossing the MMA in the temporal region [5]. Rupture of traumatic pseudoaneurysms of MMA would cause acute epidural hematoma.…”

Traumatic Middle Meningeal Artery and Fistula Formation with the Cavernous Sinus and a Review of the Literature on Endovascular Management of Traumatic Carotid Cavernous Fistulas

“…Many cases of middle meningeal fistula in association with head trauma were reported. [1][2][3][4][5][6][7][8][9][10][11][12] However, we are not aware of a reported case treated by detachable balloon and without skull fracture. In the present case, one month passed between head injury and the appearance of intracranial bruits.…”

“…Endovascular embolization is the treatment choice of the DAVF of the middle meningeal artery, and has some advantages over surgical treatment. [1,[3][4][5]9] Embolic materials should be selected carefully depending on the type and size of the lesions to prevent complications and recanalization. [1,[3][4][5]9] In our cases, we used detachable balloon to treat the DAVF, which resulted in successful embolization.…”

“…[1][2][3][4][5][6][7][8] This vascular lesion might be missed unless it exhibits clinical manifestations or are incidentally discovered during radiological examination such as magnetic resonance imaging or conventional angiography. [1][2][3][4][5][6][7][8] Here we present a case of traumatic middle meningeal artery, which subsequently established a fistula with the cavernous sinus. We also discuss the methods used for treatment of traumatic carotid cavernous fistulas [TCCFs].…”

Incidental traumatic pseudoaneurysm of the middle meningeal artery- case report and literature review.

“…The interval between trauma and pseudoaneurysm rupture ranges from 1 day to 1 year (3,14,17). Various treatment options are available, ranging from craniotomy and excision (9,17), embolization (8,13) to conservative management (12,16,18,19).…”