True aneurysm of superficial temporal artery accompanying multiple intracranial aneurysm

Abstract

Superficial temporal artery (STA) aneurysms are very infrequent. Moreover, true aneurysms, which are not pseudoaneurysms associated with trauma or previous surgery are even rarer. With this manuscript, authors present a case of a 79-year-old woman suffering from subarachnoid hemorrhage whose radiological examinations revealed multiple intracranial aneurysms along with an STA aneurysm. This very rare case, to the best of our knowledge, the second case reported so far, might contribute to the literature and lead further investigations toward the rare association between intracranial aneurysms and STA aneurysms.

Congenital True Aneurysm of the Right Superficial Temporal Artery

“…While according to Delen 1 ,approximately 400 posttraumatic STA pseudoaneurysms are reported, only 34 true aneurysms are published. The etiology includes atherosclerosis, usually met in the elderly, occasionally with hemodynamic wall stress ( 1 - 3 ). Congenital arterial wall defects due to arterial elastic membrane alterations, seems to be a primary cause for true aneurysms; according to Kawai ( 4 ) there is a high ratio of patients under 20 years of age with spontaneous STAAs; this strengthens the congenital component ( 1 , 2 ).…”

“…The etiology includes atherosclerosis, usually met in the elderly, occasionally with hemodynamic wall stress ( 1 - 3 ). Congenital arterial wall defects due to arterial elastic membrane alterations, seems to be a primary cause for true aneurysms; according to Kawai ( 4 ) there is a high ratio of patients under 20 years of age with spontaneous STAAs; this strengthens the congenital component ( 1 , 2 ). In the case of the patient we present here, we assume that his true aneurysm was congenital due to his history- a fast flow malformation, according to Hamburg classification ( 3 ).…”

“…Superficial TAAs appear equally in both sexes; few are painful or accompany other extracranial or intracranial aneurysms ( Table 1 ) ( 1 , 2 , 4 , 5 - 20 ). Few are related to subarachnoid hemorrhage and intracranial aneurysms, to Ehlers-Danlos and Marfan syndromes, or multicystic kidney ( 1 , 2 ). Intracranial vessel investigation is justified in patients with true STAAs ( 2 ).…”

“…Commonly, patients with STAAs present with a pulsatile painful or nonpainful mass at some point along the artery, throbbing headache or ear discomfort or with dizziness, bleeding, or rarely neurologic deficits, as facial nerve paralysis ( 1 , 2 , 4 ).…”

“…Differential diagnosis includes lipoma, hematoma, lymphadenopathy, supraorbital nerve neuroma, dural arteriovenous fistula, arteritis, cysts, neoplastic disease as facial nerve schwannoma, parotid gland tumor, meningocele, pericranial sinus and subcutaneous abscess ( 2 , 4 ). Occasionally STAA resembles a parotid mass involving the facial nerve, that may require superficial parotidectomy ( 1 ).…”