INTRACRANIAL VASCULAR LESIONS ASSOCIATED WITH SMALL EPIDURAL HEMATOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 416-421 ◽  
Author(s):  
Almir F. de Andrade ◽  
Eberval G. Figueiredo ◽  
Jose G. Caldas ◽  
Wellingson S. Paiva ◽  
Robson L.O. De Amorim ◽  
...  
Keyword(s):  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
External Carotid ◽  
Crossing Over ◽  
Computed Tomographic ◽  
Active Extravasation ◽  
History Of ◽  
Meningeal Artery ◽  
Early Filling

Abstract OBJECTIVE We studied the angiographic findings in patients with small epidural hematomas and cranial fractures crossing over the trajectory of the middle meningeal artery and its branches. Additionally, the occurrence of traumatic vascular lesions and their clinical relevance and treatment are discussed. METHODS A consecutive analysis was performed for 24 patients who harbored small epidural hematomas in middle meningeal artery topography associated with cranial fractures. Computed tomographic scans and plain x-ray studies were used to diagnose linear cranial fractures. Patients with large epidural hematomas or associated traumatic lesions were excluded from the study. Selective ipsilateral external carotid angiograms were obtained, and an endovascular procedure was performed if any vascular injury was evidenced. RESULTS In all patients with cranial fractures crossing over the middle meningeal artery and its branches, some kind of vascular lesion was seen. Two types of findings were noted: active extravasation of the contrast medium (71%) and pseudoaneurysms (29%). Early filling of diploic vessels was found in 8.3% of fractures concomitantly with active extravasation. Embolization was performed in all patients. No additional enlargement of the epidural hematoma was observed, and the postoperative period was uneventful. CONCLUSION This study shows that pseudoaneurysms and active extravasation of contrast are common findings in this subset of patients. Although the natural history of these lesions is still poorly understood, additional investigation with ipsilateral external carotid angiography may be recommended, considering the potentially catastrophic consequences of late rupture.

Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma

2020 ◽  
Vol 12 (4) ◽  
pp. 436-436 ◽  
Author(s):  
Gary B Rajah ◽  
Michael K Tso ◽  
Rimal Dossani ◽  
Kunal Vakharia ◽  
Adnan H Siddiqui
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
External Carotid ◽  
Invasive Treatment ◽  
History Of ◽  
The Right ◽  
Meningeal Artery

This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.

scholarly journals Computed Tomography Angiography for Detection of Middle Meningeal Artery Lesions Associated with Acute Epidural Hematomas

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Wellingson Silva Paiva ◽  
Almir Ferreira Andrade ◽  
Robson Luis Oliveira De Amorim ◽  
Edson Bor-Seng-Shu ◽  
Gabriel Gattas ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Traffic Accidents ◽  
Epidural Hematoma ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
Conventional Angiography ◽  
Cerebral Angiogram ◽  
History Of ◽  
Acute Epidural Hematoma ◽  
Meningeal Artery

Background.The natural history of traumatic aneurysms of the middle meningeal artery (MMA) is not well known, but patients with these lesions are more likely to have delayed bleeds. In this paper, we described a series of patients with epidural hematoma who underwent angiotomography (CTA) for MMA vascular lesion diagnosis.Methods.Eleven patients admitted to our emergency unit with small acute epidural hematoma were prospectively studied. All patients with temporal acute epidural hematomas underwent CTA and cerebral angiogram at our institution for diagnosis of posttraumatic lesions of middle meningeal artery. The findings of angiotomography and digital angiography were reviewed by radiologist and angiographers, respectively, to ensure that the lesions were readily diagnosed without knowing the results of angiotomography and to compare CTA findings with standard angiogram.Results.The causes of head injury were traffic accidents, falls, and aggression. Three of these patients presented traumatic MMA pseudoaneurysm. CT angiography was able to diagnose all of them, with dimensions ranging from 1.5 to 2.8 mm. Conventional angiography confirmed the findings of CT angiography, and the lesions presented with similar dimensions at both methods.Conclusions.We believe that angiotomography can be a useful technique for diagnosis of vascular lesion associated with small epidural hematoma.

Abstract 1122‐000177: Dural Arteriovenous Fistulas with Traumatic Subdural Hematomas: A Case Series

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mohamed Shehabeldin ◽  
Larami Mackenzie ◽  
Hana Choe ◽  
Osman Kozak
Keyword(s):  
Cerebral Angiography ◽  
Case Series ◽  
Middle Meningeal Artery ◽  
External Carotid ◽  
Complete Evaluation ◽  
True Incidence ◽  
Arteriovenous Fistulas ◽  
Subdural Hematomas ◽  
History Of ◽  
Meningeal Artery

Introduction : Dural arteriovenous fistula (dAVF) is a pathological shunt between the dural arterial supply and venous system including cortical veins and/or venous sinuses. Middle meningeal artery (MMA) embolization as an indication for chronic subdural hematomas (SDH) treatment has been evolving over the past few years. The relationship between traumatic SDH and dAVF is not well established. Methods : Twenty‐one consecutive patients who received MMA embolization for chronic SDH performed in a single center from July 2020 to June 2021 were reviewed. We report a series of four cases of dAVF discovered immediately before or during MMA embolization for chronic SDH secondary to trauma. Results : 15/21 (71%) patients were traumatic SDH. 4/15 (27%) of the patients were found to have dAVF on cerebral angiography immediately before or during MMA embolization. In two patients, the dAVF was demonstrated via super‐selective microcatheter angiography of the external carotid and middle meningeal artery prior to embolization. The two patients, dAVF developed via the MMA distal to catheter placement during embolizing agent administration. These latter fistulae were uncovered due to the change of vascular resistance to surrounding meningeal branches. All four fistulae were successfully obliterated. Conclusions : Our case series demonstrate that traumatic SDH can be associated with dAVF. These fistulae may be associated with persistent SDH collections or refractory reaccumulations. While the true incidence and natural history of dAVF associated with traumatic SDH is unknown, we posit that cerebral angiography may be a necessary component in the complete evaluation of traumatic SDH.

Middle Meningeal Origin of the Ophthalmic Artery

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 401-407 ◽  
Author(s):  
Qingliang Liu ◽  
Albert L. Rhoton
Keyword(s):  
Ophthalmic Artery ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Microsurgical Anatomy ◽  
Superior Orbital Fissure ◽  
Anatomic Dissection ◽  
Retinal Artery ◽  
Arteries And Veins ◽  
Meningeal Artery

Abstract OBJECTIVE To examine the microsurgical anatomy and clinical significance of an anomalous origin of the ophthalmic artery from the middle meningeal artery. METHODS In the course of an anatomic study of the cavernous sinus, an anomalous ophthalmic artery arising from the middle meningeal artery was found. To further define the anatomy of the region, five additional skulls, in which the arteries and veins were injected with colored latex, were dissected using 3× to 40× magnification. RESULTS The anomalous ophthalmic artery arose from the frontal branch of the middle meningeal artery, passed through the superior orbital fissure, and supplied the entire contents of the orbit, as well as giving rise to the central retinal artery. This study provides the first display of this anomaly in an anatomic dissection. CONCLUSION The ophthalmic artery may infrequently arise from the middle meningeal artery. This anomaly places the ophthalmic artery at risk during procedures in which the dura is elevated from the greater and lesser wings of the sphenoid or when the sphenoid ridge is removed and during embolization procedures involving the branches of the external carotid artery.

A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses

2007 ◽  
Vol 106 (1) ◽  
pp. 142-150 ◽  
Author(s):  
Paolo Perrini ◽  
Andrea Cardia ◽  
Kenneth Fraser ◽  
Giuseppe Lanzino
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Endovascular Procedures ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Retinal Artery ◽  
Meningeal Artery

Object The authors studied the microsurgical anatomy of the ophthalmic artery (OphA), paying particular attention to its possibly dangerous anastomoses with the middle meningeal artery (MMA). Methods The microsurgical anatomy of the OphA and its anastomoses with the MMA were studied in 14 vessels from seven adult cadaveric heads. The origination order of the OphA branches varies in relation to whether the artery, along its intraorbital course, crosses above or below the optic nerve (ON). The central retinal artery is the first branch to course from the OphA when it crosses over the ON, and it is the second branch to course from the OphA when the artery crosses under the ON. Anastomoses between branches of the MMA and the OphA were present in the majority of the specimens examined. Conclusions Detailed knowledge of the microanatomy of the OphA and recognition of anastomoses between the external carotid artery and the OphA are critically important in avoiding disastrous complications during endovascular procedures.

The Value of the Middle Meningeal Artery in Cerebrovascular Bypass Surgery: An Anatomic Feasibility Study

2017 ◽  
Vol 15 (1) ◽  
pp. 89-96 ◽  
Author(s):  
Hamid Reza Niknejad ◽  
Albert van der Zwan ◽  
Sam Heye ◽  
Frank Van Calenbergh ◽  
Johannes Van Loon
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Middle Meningeal Artery ◽  
External Carotid ◽  
Silicone Injection ◽  
Significant Difference ◽  
Cerebrovascular Surgery ◽  
Meningeal Artery

Abstract BACKGROUND Over the past decade, there has been a revival and a renewed interest for cerebrovascular bypass procedures. The superficial temporal artery (STA) has its value as a reliable donor vessel; however, a possible role for the middle meningeal artery (MMA) as a donor artery is still unclear. OBJECTIVE To assess the feasibility of using the MMA as a donor vessel in cerebrovascular surgery. METHODS We performed cadaveric dissections on 12 fresh specimens (23 sides) after bilateral silicone injection into the internal and external carotid arteries. We compared the size, diameter, and possibility to perform a bypass to the middle cerebral artery for both the MMA and the STA. Measurements were done using an electrical caliper. Additional measurements of the MMA and STA were performed on 20 random angiograms. RESULTS There was no statistically significant difference in diameter of the MMA at its ostium being 2.4 mm, compared to 2.7 mm for the STA ostium (t-test; P = .21). The MMA could be mobilized over 4.1 cm, whereas the STA over 8.3 cm. Finally, the mean diameter of the donor vessel at the site of the anastomosis was 1.6 mm versus 1.9 mm for MMA and STA, respectively (P = .0026). We were able to perform an MMA and middle cerebral artery anastomosis on 17 sides. CONCLUSION These results suggest that the MMA is a potentially valuable donor vessel to be used in selected cases. The availability of a suitable MMA branch should be assessed preoperatively on the angiogram.

scholarly journals Arteriovenous malformation presenting as traumatic subdural hematoma: A case report

2020 ◽  
Vol 11 ◽  
pp. 203
Author(s):  
Matthew Parr ◽  
Nitesh Patel ◽  
John Kauffmann ◽  
Fawaz Al-Mufti ◽  
Sudipta Roychowdhury ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Emergency Services ◽  
Vascular Lesion ◽  
Initial Presentation ◽  
Vascular Lesions ◽  
Hematoma Expansion ◽  
Preoperative Embolization ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion

Background: Brain arteriovenous malformations (AVMs) are congenital aberrant connections between afferent arteries and draining veins with no intervening capillary bed or neural parenchyma. Other than seizures, the most common initial presentation of AVM is hemorrhage, which is typically intraparenchymal, subarachnoid, or intraventricular, and very rarely subdural. Case Description: This patient is a 66-year-old male with a history of atrial fibrillation, chronically anticoagulated with apixaban, who presented through emergency services after a fall. On presentation, computed tomography (CT) of the head showed a small, 6 mm right subdural hematoma, and the patient was neurologically intact. The hematoma was evacuated by burr hole craniotomy and placement of a subdural drain 12 days after the initial presentation due to worsening headaches and further hematoma expansion. Two weeks postevacuation, the patient was readmitted for seizures, and at this time, CT angiography showed no intracranial vascular lesion. Approximately 1 month later, the patient was readmitted for decreased responsiveness, and CT head at this time found right frontal intraparenchymal hemorrhage. On subsequent catheter angiography, the right frontal AVM was discovered. It was treated with preoperative embolization followed by surgical resection. Postoperatively, the patient followed commands and tracked with his eyes. There was spontaneous antigravity movement of the right upper extremity, but still no movement of the left upper or bilateral lower extremities. Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for underlying vascular lesions when evaluating intracranial bleeding, even in the setting of traumatic history, particularly in cases of hematoma expansion.

Chronic headaches and middle meningeal artery embolization

2021 ◽  
pp. neurintsurg-2021-017602
Author(s):  
Joshua S Catapano ◽  
Katherine Karahalios ◽  
Visish M Srinivasan ◽  
Jacob F Baranoski ◽  
Caleb Rutledge ◽  
...  
Keyword(s):  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Telephone Call ◽  
History Of ◽  
Chronic Headaches ◽  
Gcs Score ◽  
The Relationship ◽  
Headache Impact ◽  
Meningeal Artery

BackgroundThe middle meningeal artery (MMA) has been implicated in chronic headaches, but no studies have examined the relationship between MMA embolization and headaches.MethodsPatients treated with MMA embolization for a chronic subdural hematoma (cSDH) between January 1, 2018, and December 31, 2020, were retrospectively assessed. Patients with a Glasgow Coma Scale (GCS) score of 15 at discharge received a follow-up telephone call to assess their history of chronic headache, defined as a headache ≥2 years before the cSDH and symptoms ≥2 days/month. A Headache Impact Test (HIT-6) was performed during the follow-up telephone call. The primary outcome was resolution or improvement of headaches after embolization.ResultsOf 76 patients undergoing MMA embolization for a cSDH during the study period, 56 (74%) had a discharge GCS score of 15. Of these 56 patients, 46 (82%) responded to a follow-up telephone call and were analyzed (mean [SD] age 68 [11] years; 36 [78%] men and 10 [22%] women). Nine (20%) reported chronic headaches before embolization. With a mean (SD) follow-up of 489 (173) days, eight of the nine patients reported improvement of chronic headaches, with seven having complete resolution. For these nine patients, the mean (SD) HIT-6 score was significantly higher before embolization than after embolization (64 [7.1] vs 40 [9.1], p<0.001).ConclusionIn patients with chronic headaches who underwent MMA embolization for a cSDH, the majority reported improvement of headaches after the procedure. Future prospective studies are warranted to assess the usefulness of MMA embolization to treat chronic headaches.

Technique to “Trap” a Segment of the Middle Meningeal Artery for Embolization of a Carotid Cavernous Fistula: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
MirHojjat Khorasanizadeh ◽  
Mira Salih ◽  
Dominic Harris ◽  
Christopher S Ogilvy
Keyword(s):  
Internal Carotid ◽  
Transarterial Embolization ◽  
Cranial Nerves ◽  
Middle Meningeal Artery ◽  
Type D ◽  
History Of ◽  
Nerve Paresis ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach ◽  
Meningeal Artery

Abstract Transvenous embolization is the favored treatment for indirect carotid-cavernous fistulas (CCFs). However, transarterial embolization can be used as an alternative method when the venous route is inaccessible. We present the case of a 47-yr-old woman with a history of diplopia, headaches, and sixth cranial nerve (CN-VI) palsy who presented with acute worsening of headache and ophthalmoplegia and rise of intraocular pressures. Angiography demonstrated a left indirect CCF (dural arteriovenous malformation) with multiple arterial feeders from the internal carotid artery as well as the middle meningeal artery (MMA) (Barrow type D). Transvenous approach was attempted first but was unsuccessful due to difficult access to the cavernous sinus. Thus, transarterial embolization through the MMA feeding branches was planned. To avoid occluding distal branches of the MMA by Onyx, we coiled it distally. In addition, we used a scepter balloon proximally to prevent the reflux of Onyx into potential collaterals to cranial nerves from proximal MMA. After trapping a segment of the MMA, Onyx was injected into the CCF fistula through the small MMA feeders. A postembolization arteriogram showed obliteration of the CCF. The patient developed mild left facial nerve paresis on the first postoperative day (thought to be related to partial embolization of tiny arteries in the facial canal), which was resolving in the course of hospitalization. She remained neurologically stable, and was discharged on the third postoperative day. To the best of our knowledge, this is the first report of transarterial embolization of CCF by distal coiling and proximal ballooning to trap a segment of an artery. The authors hereby confirm that informed consent was obtained from the patient after thorough discussion of the procedure's rationale, risks, benefits, and alternatives.

Abstract 1122‐000148: Rare Anterior Inferior Cerebellar Artery Origin of Middle Meningeal Artery

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Samer Abdul Kareem ◽  
Arsalan Anwar ◽  
Nicholas Liaw ◽  
Mustafa Kareem ◽  
Osama Zaidat
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Middle Meningeal Artery ◽  
External Carotid ◽  
Anterior Inferior Cerebellar Artery ◽  
Subdural Hemorrhage ◽  
Maxillary Artery ◽  
Term Care ◽  
Anatomical Variant ◽  
Cerebellar Artery ◽  
Meningeal Artery

Introduction : Middle meningeal artery (MMA) anatomy has very important surgical implications during endovascular and open based skull procedures. Various anatomical origins have been identified in the literature besides its most common origin as the largest branch of the maxillary artery. It runs parallel and close contact of the lateral skull face therefore during trauma to this area is prone to rupture resulting in subdural hemorrhage(SDH). In our case report, we present its peculiar origin from anterior inferior cerebellar artery which has never been reported before. The origin of MMA may reflects the risk involved with embolization therapy for chronic SDH. Methods : A case of MMA originated form AICA. A literature review was conducted of reports of MMA origins. Results : A 35‐year‐old male with a history of alcohol abuse presented to the ED after falling down from the stairs. In the ED, the patient had multiple episodes of seizures along with respiratory distress therefore was intubated due to concern of airway protection. CT head showed bilateral SDH. Patient underwent diagnostic angiogram for possible bilateral embolization of MMA. During the procedure, the left MMA origin was seen from the AICA whereas the right MMA arising from the external carotid artery. Embolization of the left MMA was aborted. Patient remained intubated and was later transferred to a long term care facility. Conclusions : In the last 80 years, the anatomy of the MMA has been part of the discussion of various literature. Seeger et.al, highlighted the embryological changes manifested as anastomosis between Sphenomaxillary artery and lateral pontine artery resulting in origin of MMA from Basilar artery along with absence of foramen spinosum. Since 1973, multiple literature highlighted the origin of MMA including the lacrimal artery, ICA, ascending pharyngeal artery, opthalmic and occipital arteries. Recently, In 2011 Kuruvuilla et.al showed the origin of MMA from posterior inferior cerebellar artery. MMA clinical significance can be seen in multiple diseases. Older populations with chronic subdural hematomas, embolization of MMA has shown to be a less invasive and cost effective procedure. In patients with anterior and middle cranial fossa meningiomas embolization of MMA has been a crucial part of management. Similarly, understanding of its anatomy is also important while treating MMA aneurysm or pseudoaneurysms. In our case, the origin of middle meningeal artery from AICA has been significant as it supplies the posterior fossa structures and was not reported in the literature before, hence the procedure was aborted. This anatomical variant has shown us a new light upon embryological evolution and has helped us widen the horizons of our approach towards brain vasculature. This finding will help the future Interventionists to develop new ways of embolization of the MMA and understanding its anatomy.

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