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Find out how Dr Torres treated bilateral pseudoaneurysms associated with head trauma.
Right traumatic MMA pseudoaneurysm (direct trauma)
Figure 1: Simple cranial computed tomography (CT) scan: fracture of the squamous portion of the right temporal bone (A). Right frontotemporal SAH and temporal intraparenchymal hemorrhage (B)
Figure 2: Digital subtraction angiography, pseudoaneurysm of the right middle meningeal artery (MMA) (A). Endovascular embolization treatment was performed with two coils (7mm x 30cm Concerto Helix Coil and 5mm x 15cm Concerto Helix Coil) for a 100% occlusion (B).
Control angiography (serch for other causes of intracranial bleeding) showed a contralateral MMA pseudoaneurism - probably shear stress
Figure 3: Digital subtraction angiography, second pseudoaneurysm in the left MMA.
Figure 4: Endovascular embolization was performed of the second pseudoaneurysm with 21% Histoacryl for 100% occlusion.
MMA traumatic pseudoaneurysms are an infrequent pathology (<1% intracranial aneurysm) associated with head trauma. Bilateral pseudoaneurysms are even more uncommon. Because the natural history is under discussion and its mortality is high (20-25%) in case of rupture, it is important to perform an early diagnosis and timely treatment to prevent a catastrophic outcome.
