Abstract
Non-traumatic aneurysms of the middle meningeal artery (MMA) are extremely rare. We report a rare case of a MMA aneurysm (MMA AN) associated with Paget's disease of the skull, which was effectively treated with transarterial embolization. A 73-year-old woman was referred to the Department of Internal Medicine at our hospital with an elevated serum alkaline phosphatase level. Bone scintigrams using technetium-99m-hydroxy methylene diphosphonate (99mTc-HMDP) showed abnormal radioisotope uptake in the skull bones, and skull X-rays demonstrated a cotton wool appearance. Based on these findings, she was diagnosed with Paget's disease. Skull radiographs also showed intracranial platinum coils conforming to her history of coil embolization performed for the treatment of MMA AN. Magnetic resonance angiography revealed recurrence of a left MMA AN, and she underwent transarterial embolization using coils and n-butylcyanoacrylate. Because of an abundant blood supply to the skull, hemostatic complications might occur in patients with Paget's disease undergoing surgery. Therefore, endovascular embolization is a safe and effective treatment in such patients.
