Traumatic pseudoaneurysm of the superficial temporal artery

Abstract

Aneurysms of the facial vasculature due to various accidental, violent, and surgical injuries have been reported since mid-17th century. Approximately 386 pseudoaneurysms of the superficial temporal artery (STA) have been reported in the literature since 1644. Traumatic pseudoaneurysm of the STA is a rare lesion. It manifests as a painless pulsatile mass in the temporal region following trauma. The unusual incidence and confusing presentation require the clinicians to have a thorough knowledge of its presentation and diagnosis. We present a case of traumatic pseudoaneurysm of the STA, which developed a few weeks later, after sustaining blunt trauma to the head. We have also reviewed the anatomical challenges and pathophysiology that promotes the formation of pseudoaneurysm and the optimal approach to diagnose and manage the lesion. Pulsatile lesions or lesions that are continuous with the STA should be regarded with extreme caution. The sole treatment modality is surgical resection of the pseudoaneurysm. This will avoid any future complications such as hemorrhage or compression of adjacent nerves and vessels.

Traumatic Superficial Temporal Artery Pseudoaneurysm Treated With Thrombin Injection

“…In some cases, the examiner may notice a decrease or loss of pulsation when the proximal superficial temporal artery is manually compressed. 3,7 Color Doppler ultrasound is a critical portion of the assessment. Findings include demonstration of a pseudocapsule with a typical "ying-yang" flow pattern (Figure 2b).…”

Endovascular embolisation of an iatrogenic superficial temporal artery pseudoaneurysm using liquid embolic

“…Most cases present with a progressively enlarging pulsatile mass that can present acutely (within days) or months after vessel injury. Though many patients remain otherwise asymptomatic beyond the obvious cosmetic deformity, headache, facial pain, or facial palsy (due to the proximity of the facial nerve in this location) have been reported 4 10 11…”

“…Expedient management is critical, as these lesions are prone to rupture given the weakness of the intimal wall surrounding them. While surgical resection by ligating the afferent and efferent supplies remains the treatment of choice, endovascular management is an alternative management strategy 3 5 6 11 13. Current reports describe coil embolisation of the efferent branches of the STA supplying the pseudoaneurysm.…”

Pseudoaneurisma de arteria temporal superficial traumática

“…3 El cuadro clínico de esta patología se caracteriza por la aparición progresiva de un aumento de volumen en la región temporal, precedida usualmente por un traumatismo en dicha región de dos a seis semanas previas; sin embargo, existen reportes de aneurismas tardíos con presentación hasta de ocho años después del traumatismo. 4 Clínicamente aparece como una masa quística pulsátil en la región de la frente y debe sospecharse si aparece poco después de un trauma contuso. Dicha tumoración tiende a ser pulsátil, comprimible, no dolorosa, de bordes regulares, que tiende a disminuir de tamaño al oprimir la ATS proximal.…”

“…En caso de ruptura puede ocasionar hemorragia masiva o edema hemifacial severo. 6 Los pacientes posiblemente consulten a un dermatólogo, cirujano plástico o neurocirujano. Esta entidad rara puede ser confundida con un quiste de inclusión o inclusive lipoma, así que los diagnósticos diferenciales y las investigaciones especiales son imprescindibles si se intenta cualquier tratamiento curativo.…”