2020 Volume 43 Issue 2 Pages 75-79
Pseudoaneurysm of the middle meningeal artery (MMA) is a rare entity and is generally associated with traumatic brain injury. We reported a case of pseudoaneurysm of the MMA after frontotemporal craniotomy. A 71–year–old female presented with headache and dizziness, and was diagnosed as having subarachnoid hemorrhage due to ruptured aneurysm of the anterior communicating artery. Clipping of the aneurysm was performed by frontotemporal craniotomy via a trans sylvian approach. At 25 days after the surgical procedure, 3D CT angiography (3D–CTA) revealed aneurysm of the MMA. Cerebral angiography was performed at 29 days after surgery, and a 4–mm aneurysm with pooling of contrast agent was observed in the posterior branch of the MMA. Rapid aneurysmal growth was observed when compared to the cerebral angiography performed on the 8th postoperative day for the purpose of evaluating cerebral vasospasm. The aneurysm was located within the craniotomy, and trapping was performed on the aneurysm at 33 days after surgery. The aneurysm was excised and submitted for examination as a pathology specimen. The defect in the arterial wall and spilled blood were lined by surrounding connective tissue, and a diagnosis of pseudoaneurysm was made. This case was considered as pseudoaneurysm due to iatrogenic injury triggered by craniotomy. A few cases of pseudoaneurysm of the MMA have been described in the literature and are mostly associated with head injury, not iatrogenic. Since pseudoaneurysm has a high mortality rate after rupture, sufficient hemostasis of the MMA during surgery is required. Furthermore, it is important to perform imaging examinations due to the possibility of pseudoaneurysm.
