外傷性中硬膜動脈瘤の２例

抄録

Traumatic Middle Meningeal Artery Aneurysm (TMMA) is rare and associated with high mortality (20 – 50%). Skull fracture is usually an associated feature of this entity (70 – 90%). We present two cases of TMMA after head injury with acute epidural hematoma. One case was treated by endovascular therapy before rupture. The other case was conservative therapy because TMMA spontaneously regressed. The both of two cases had good outcome. Only little is known about the natural history of TMMA and the treatment guidelines. However, some authors suggested that TMMAs are more common than the previously thought. It is important to be aware of possible TMMAs in case of head trauma, especially with the fracture of temporal bone near the middle meningeal artery because they can lead to acute or delayed intracranial hemorrhage associated with high mortality. Surgical treatment or endovascular treatment is selected for TMMAs. Recent reports suggested that endovascular treatment is widely used as the first approach for TMMAs because it is minimally invasive, feasible and effective. It is possible that more of TMMAs will be detected with increased use of noninvasive vascular imaging such as 3D-CTA and MRI/A.