2020 Volume 43 Issue 1 Pages 33-36
We report a case of coil embolization for a patient who showed progressive growth of a traumatic middle meningeal artery aneurysm (TMMA) and dural arteriovenous fistula (dAVF).
A 56–year–old woman was transported to our hospital with, suspected high–energy trauma. Acute epidural hematoma and multiple bone fractures were seen on head CT, but CT angiography (3DCTA) showed no obvious traumatic vascular injury. On the day after the injury, no obvious neurological deterioration was observed. MRI was performed on the 7th day for headache and cerebral contusion, and a right pseudoaneurysm of the middle meningeal artery was found suspected to be TMMA. Cerebral angiography performed on the 10th disease day revealed a right dAVF in addition to the right TMMA. Coil embolization was performed on the lesion, after which the headache disappeared and the lesions disappeared on 3DCTA.
In cases where a skull fracture is observed due to high–energy trauma, TMMA should be considered, with screening for traumatic vascular lesions using noninvasive MRA or 3DCTA. In addition, traumatic vascular injury may progress and needs to be evaluated over time.
