Three-dimensional computed tomography angiography for the investigation of superficial temporal artery pseudoaneurysms--two case reports--

An 89-year-old man and a 60-year-old man presented with superficial temporal artery (STA) pseudoaneurysms which developed secondary to trauma. Conventional cerebral angiography and three-dimensional computed tomography (3D CT) angiography clearly demonstrated the STA pseudoaneurysms. The patients underwent surgical excision of the aneurysms based on the conventional cerebral angiography findings in one patient and 3D CT angiography findings in other patient. 3D CT angiography is an excellent noninvasive diagnostic method for detecting extracranial aneurysms such as STA pseudoaneurysm, especially the relationship between the aneurysm and surrounding structures, including the calvarium.     

Traumatic pseudoaneurysm of the superficial temporal artery treated by endovascular coil embolization

We describe an exceptional case of a traumatic pseudoaneurysm of the superficial temporal artery (STA), which was treated with microcoil embolization of the anterior branch of the STA. We conclude that endovascular coil embolization can be an option of in the treatment of STA pseudoaneurysms.     

Pseudoaneurysm of the superficial temporal artery following craniotomy--case report

A 48-year-old male without marked blood coagulation disorder developed a pseudoaneurysm of the superficial temporal artery (STA) following craniotomy. Cerebral angiography revealed a pseudoaneurysm on the parietal branch of the STA. Total extirpation was performed, and the postoperative course was uneventful. Most pseudoaneurysms of the STA develop after trauma. Lesions rarely develop after craniotomy. However, pseudoaneurysm of the STA should be considered as a possible surgical complication.     

Multiple arteriosclerotic fusiform aneurysms of the superficial temporal artery--case report

Superficial temporal artery (STA) aneurysms are very rare, and usually occur in young adult men due to blunt trauma as pseudoaneurysms. An 85-year-old male presented with two non-traumatic STA aneurysms. The aneurysms were ligated and resected. Histological examination showed arteriosclerotic fusiform aneurysm. The pathogenesis of non-traumatic aneurysm of the STA appears to be arteriosclerotic change and/or hemodynamic stress.     

A case of multiple superficial temporal artery pseudoaneurysms following craniotomy

A case of multiple superficial temporal artery (STA) pseudoaneurysms following craniotomy is reported and a review of the literature is made. The patient was a 17-year-old male who was hospitalized as he developed right hemiparesis 4 hours after golf ball injury to the left temporal region. He had been diagnosed as hemophilia A one year prior to the injury. CT scan showed right parietal intracranial hematoma with mass effect when he was submitted to emergency craniotomy. At surgery a linear scalp incision was made over the left temporal area after high factor VIII concentrates (con-VIII), 2,000 units, were administered. His postoperative course was uneventful and hemiparesis improved substantially, however two pulsatile masses along the incision scar over the scalp were noticed some 40 days after the hematoma removal. There was another pulsating mass in the left wrist where an arterial cannulation was made at the time of craniotomy. Selective angiograms showed two left STA pseudoaneurysms and left radial pseudoaneurysm was also demonstrated. The left STA was embolized with Gelfoam pieces through catheterization after administration of con-VIII, and the radial artery aneurysm was surgically resected. There was no evidence of recurrence of these lesions during the follow-up period of eight months. Among over 130 cases of STA pseudoaneurysms reported, there was no case with hemophilia and also no such a case described which developed after craniotomy on reviewing the literature. And it was proved that con-VIII has enabled a patient to tolerate embolization procedure through catheterization.     

Branch ligatures and blood aspiration for post-traumatic superficial temporal artery pseudoaneurysm: surgical technique

The aim of this study is to report a new minimally invasive technique of superficial temporal artery (STA) pseudoaneurysm treatment. Several surgical options have been employed to treat STA pseudoaneurysms. To address this rare condition, the employed techniques are ligation and excision of the aneurysm, endovascular coil embolization or percutaneous ultrasound-guided thrombin injection. Between techniques no significant differences are reported in terms of outcomes. The decision to adopt a technique depends on STA pseudoaneurysm morphology and surgeon preference. In the present report, STA pseudoaneurysm afferent and efferent branches were identified by ultrasound in a 92-year-old female. Under local anaesthesia, these branches were ligated through small skin incisions. STA pseudoaneurysm decompression was obtained by an ‘over the needle aspiration’. A compressive dressing was left in space for 48 h.     

Traumatic superficial temporal artery pseudoaneurysms in a minor league baseball player: a case report and review of the literature

Traumatic STA aneurysm is a rare complication of facial trauma occuring typically in young men. We present the case of a minor league baseball player who developed 2 pseudoaneurysms after being struck by a baseball and review all cases associated with sports activities. Reports associated with sports activities are increasing and may represent an increasing incidence. The team physician should suspect this condition when a player presents with a new temporal mass after facial trauma. Diagnosis is typically made on history and physical examination, but can be confirmed by duplex ultrasound. Definitive treatment is surgical resection of the aneurysm after proximal and distal ligation of the vessel.     

Pseudoaneurysms of the superficial temporal artery secondary to placement of external ventricular drainage catheters

BACKGROUND: Pseudoaneurysms of the superficial temporal artery have been described following trauma and various surgical procedures. There are no reports in the literature of these lesions following the placement of external ventricular drainage catheters. This article describes two patients and their successful treatment, and reviews diagnostic and treatment strategies. CASE DESCRIPTION: Two patients developed tender, nonpulsatile masses in the scalp along the former subcutaneous tract of an EVD catheter. Both lesions were successfully excised in the operating room and found to be thrombosed pseudoaneurysms of the superficial temporal artery. CONCLUSION: Pseudoaneurysms of the parietal branch of the STA may occur secondary to incision of the skin for twist drill hole placement or the use of a sharp trocar for subcutaneous tunneling of catheters. Use of a blunt-tipped trocar may reduce the risk of developing pseudoaneurysms secondary to EVD placement. Knowledge of the possibility of developing these lesions from catheter placement may aid the neurosurgeon in proper diagnosis and treatment.     

Splenic pseudoaneurysms following acute pancreatitis]

Splenic artery pseudoaneurysms are the most common of visceral artery pseudoaneurysms. Splenic pseudoaneurysms appear to have developed as a consequence of inflammatory processes adjacent to the splenic artery, particularly acute pancreatitis and chronic pancreatitis with associated pseudocysts. They are often asymptomatic and picked up on abdominal examination for ultrasound or CT scanning for other conditions. Complications include rupture with retroperitoneal hemorrhage or intraperitoneal hemorrhage. Two cases of splenic pseudoaneurysms, following acute pancreatitis, are reported between the years 1987 and 1996.     

Color duplex-guided compression therapy for postcatheterization pseudoaneurysms in a community hospital

Diagnostic or therapeutic arterial catheterization may be complicated by postcatheterization pseudoaneurysm. Pseudoaneurysms have generally been treated surgically, but more recently, encouraging results with duplex-guided compression therapy (DGCT) of pseudoaneurysms have been reported from university hospitals. We reviewed our experience with DGCT to assess the applicability of DGCT in a community hospital setting. Sixty-two patients presented with 63 symptomatic postcatheterization pseudoaneurysms between January 1, 1990, and December 31, 1993. Prior to October 28, 1991, all pseudoaneurysms were treated surgically. Subsequently we initiated DGCT as primary treatment for pseudoaneurysms, reserving surgery for DGCT failures and unstable patients. DGCT patients were indistinguishable from primary surgery patients, and the number of pseudoaneurysms treated did not appear to increase during the study period. DGCT was initially successful in 27 (75%) of 36 patients. Three pseudoaneurysms recurred, yielding cumulative success in 24 (67%) of 36 patients. Three of 12 DGCT failures were due to patient intolerance. DGCT was unsuccesful in three of four intra-aortic balloon pump (IABP)-associated pseudoaneurysms. There was some variation in pseudoaneurysm volume between the successful and failed groups, and a trend toward failure with larger pseudoaneurysms was not significant (13 vs. 6 cm³,p0.25). DGCT failure appears more likely in post-IABP pseudoaneurysms and possibly with larger pseudoaneurysms. Anticoagulation, type of procedure (exclusive of IABP), obesity, and other patient characteristics examined did not appear to predict success or failure of DGCT. Treatment was reserved for symptomatic patients throughout the period of study and there was no evidence that patients were more likely to be treated for pseudoaneurysms after DGCT was initiated. We conclude that DGCT is usually successful and is appropriate primary treatment for all symptomatic postcatheterization pseudoaneurysms in stable patients.Presented at the Eighteenth Annual Meeting of the Mid-western Vascular Surgical Society, Cincinnati, Ohio, September 24, 1994.     

The changing epidemiology of pseudoaneurysm. Therapeutic implications

To elucidate newly emerging trends in pseudoaneurysm causation, 57 patients with 81 pseudoaneurysms were reviewed. Only two (8%) of 24 pseudoaneurysms treated surgically before 1977 were infected, whereas 17 (30%) of 57 treated during the past decade were infected. There were four deaths among 12 patients (33%) with infected pseudoaneurysms compared with only one death among 45 patients (2%) with noninfected pseudoaneurysms. All five amputations were consequences of infected pseudoaneurysms. We conclude that (1) infection as a cause of pseudoaneurysm is increasing, (2) mortality and limb loss are now confined almost exclusively to cases involving infection, and (3) the current approach to pseudoaneurysm should include a high index of suspicion in patients at risk for infection, increased use of newer diagnostic scans, and an aggressive surgical attack on infected pseudoaneurysms that may require complete graft excision and extra-anatomic bypass.     

Intracerebral hemorrhage from a ruptured pseudoaneurysm after STA-MCA anastomosis--case report

A 43-year-old hypertensive male developed a pseudoaneurysm at the site of a superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, causing massive intracerebral hemorrhage 5 years after the operation. He first experienced repeated transient ischemic attacks, and cerebral angiography disclosed complete occlusion in the cervical portion of the left internal carotid artery. STA-MCA anastomosis was performed, and the ischemic attacks stopped. Postoperative angiography confirmed patency of the anastomosis and good filling of the cortical branches of the left MCA. Five years after surgery, the patient suffered sudden onset of generalized convulsions and consciousness disturbance. Computed tomography disclosed a massive intracerebral hemorrhage in the left frontoparietal region, and angiography revealed an aneurysmal dilatation at the site of the anastomosis that was not seen before. Emergency evacuation of the hematoma and clipping of the aneurysmal dilatation were performed. The patient recovered well and became ambulatory. Histological examination of the surgical specimen showed collagen tissue, indicating a pseudoaneurysm. Patients who undergo STA-MCA anastomosis, especially hypertensive patients, should be followed up by repeated magnetic resonance angiography to confirm the patency of the anastomosis and cerebral perfusion, and to detect the formation of pseudoaneurysms at the anastomosis site, which can cause fatal bleeding.     

Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudoaneurysms

HYPOTHESIS: Ultrasound-guided injection of thrombin is the treatment of choice for femoral pseudoaneurysms. DESIGN: A prospective study of patients undergoing a single form of treatment for femoral pseudoaneurysms. SETTING: Patients were treated at 2 tertiary care, university-affiliated hospitals. PATIENTS: Forty consecutive patients with femoral pseudoaneurysms resulting from diagnostic and therapeutic catheterizations for peripheral arterial, coronary arterial, and cerebrovascular diseases were evaluated. INTERVENTION: Thrombin was injected directly into the pseudoaneurysms under ultrasonographic guidance. MAIN OUTCOME MEASURE: Thrombosis of the pseudoaneurysm following thrombin injection was the goal of treatment. RESULTS: All 40 patients had initial complete thrombosis of their femoral pseudoaneurysms. In each case, except for one, the aneurysm was noted to have thrombosed on follow-up duplex ultrasonogram. There was one complication. CONCLUSION: Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudoaneurysms.     

腹部脏器假性动脉瘤诊治体会

目的 总结腹部脏器假性动脉瘤的诊断和治疗经验。方法 回顾性分析1990～2001年16例腹部脏器假性动脉瘤,其中肝动脉瘤6例、脾动脉瘤6例、胃十二指肠动脉瘤4例。全部病例均获得随访,平均2年。结果 16例假性动脉瘤病人中15例表现为破裂出血。手术3例,成功2例,死亡1例。经动脉导管栓塞13例,全部成功且无并发症及复发。结论 数字减影血管造影术对腹部脏器假性动脉瘤急诊有确诊价值,经动脉导管栓塞术是绝大多数病人首选而有效的治疗方法。     

Aneurysm of the superficial temporal artery

A young patient with the posttraumatic development of a superficial temporal artery (STA) aneurysm is described. The STA was ligated proximal and distal to the aneurysm, and the aneurysm was removed. The diagnosis and treatment of traumatic STA aneurysms are discussed.     

超声引导下经皮注射生物蛋白胶治疗医源性假性动脉瘤(附8例报道)

目的探讨超声引导下瘤腔内注射医用生物蛋白胶治疗医源性假性动脉瘤的可行性和安全性。方法采用22G穿刺针,对8例医源性假性动脉瘤患者行超声引导下瘤腔内注射生物蛋白胶,利用二维及彩色多普勒超声观察瘤腔的封堵情况,术后监测远端肢体动脉搏动,并定期随访。结果 8例患者均一次性封堵成功,生物胶用量2～4ml,瘤腔封堵时间10～40s。术后无肢体动脉栓塞和过敏反应,随访1周假性动脉瘤无复发。结论采用超声引导下瘤腔内注射生物胶治疗医源性假性动脉瘤是一种创伤小、安全、快捷有效的治疗方法。     

Three Cases of Spontaneous Superficial Temporal Artery Aneurysm with Literature Review

Spontaneous, nontraumatic, superficial temporal artery (STA) aneurysms have been rarely reported. We herewith report three cases of spontaneous and true STA aneurysms. All patients, a 65-year-old male, a 76-year-old female, and a 47-year-old female, had no history of head trauma that requires medical attention. Painless, pulsatile, and slowly growing calvarial lump was the symptom leading to image studies. All the lumps were preoperatively diagnosed as STA aneurysms by magnetic resonance angiography and/or three-dimensional computed tomographic angiography. One case was accompanied by anterior communicating aneurysm. And another case was associated with two more scalp aneurysms arising from occipital artery and contralateral STA. Pathologic studies showed that all three were true aneurysms, with intact media and adventitia but without organized hematoma. Literature review showed that 8% of all STA aneurysms comprised spontaneous STA aneurysms. We found 32 cases (19 males and 13 females) of well-described spontaneous STA aneurysms including ours. Twenty-eight cases (87.5%) were true aneurysms. Seven cases (21.9%) had coexisting vascular lesions. Five (15.6%) of these seven cases were diagnosed with cerebral or abdominal aneurysm. Multiple scalp aneurysms are quite rare; only two cases including ours have been reported. It seems important to know that spontaneous STA aneurysms may coexist with other vascular lesions including intracranial aneurysm.     

Traumatic pseudoaneurysm of the superficial temporal artery: two cases

Pseudoaneurysms of the superficial temporal artery are a rare and potentially critical cause of facial masses. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile tumors that may be associated with neuropathic findings and enlarged size. Without careful evaluation in the primary care setting, pseudoaneurysms can be easily misdiagnosed and improperly managed. They can, however, be accurately diagnosed through physical examination alone and subsequently treated with surgical ligation. The authors present two cases of traumatic pseudoaneurysms of the superficial temporal artery caused by blunt injury and discuss pertinent diagnosis and treatment options, as well as provide a brief review of the anatomy and histopathology of pseudoaneurysms.     

Traumatic pseudoaneurysms of external carotid artery branch: Case series and treatment considerations

PurposeTo explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.MethodsEleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.ResultsComplete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5–2.0 years without recurrence of nosebleed and scalp lump.ConclusionFor patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.