Traumatic middle meningeal artery pseudoaneurysm and subsequent fistula formation with the cavernous sinus: case report

Masanori Tsutsumi, Kiyoshi Kazekawa, Akira Tanaka, Yasushi Ueno, Yasuyuki Nomoto, Kohei Nii, Hiroshi Harada
Surgical Neurology 2002, 58 (5): 325-8

BACKGROUND: A combination of pseudoaneurysm and arteriovenous fistula of the middle meningeal artery is rare. We describe a case of traumatic pseudoaneurysm of the middle meningeal artery, which subsequently formed a fistula with the cavernous sinus.

CASE DESCRIPTION: A 23-year-old man suffered from blunt head trauma and skull fractures. Sixteen days later, he suddenly experienced headache and a bruit was auscultated over the left ear. Three-dimensional computed tomographic angiography revealed dilatation of the left middle meningeal artery. The dilation proved to be a pseudoaneurysm on cerebral angiograms and it was also found to have formed a fistula with the cavernous sinus. Both lesions were successfully obliterated by endovascular embolization using microcoils.

CONCLUSION: Head injury may lead to asymptomatic pseudoaneurysm or dural arteriovenous fistula. Neurosurgeons should always bear in mind the possibility of such vascular injuries after blunt head trauma to prevent any hemorrhagic complications.

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