Palpable Pulsatile Mass of the Forehead: A Case Series of Superficial Temporal Artery Pseudoaneurysms

Surgical revascularization may be beneficial in patients with ischemic stroke caused by intracranial stenosis or occlusion who are ineligible for thrombolysis. Objective To evaluate the outcome of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in ischemic stroke caused by intracranial artery stenosis or occlusion. Methods We retrospectively studied successive case series of 19 patients who underwent surgical treatment between 2013–2017 of STA-MCA bypass. Surgical procedure was performed for the patients with acute ischemic stroke who were ineligible for thrombolysis. Results Of the 19 patients enrolled, symptom aggravation occurred during medical treatment, the patients were ineligible for thrombolysis despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores, mean patient age was 78.05 years (range, 39–78 y). However, male 11 (57.95%) out of nineteen patients were presented with left-sided-lesions while female 8 (42%) had right-sided lesions with significant infarction growth by diffusion weighted imaging achieved, after surgical maneuver. No major complications occurred intraoperatively, in contrast to 2 (10.5%) minor manifestation were suffering minor complications probably they included the remote infarction (posterior cerebral artery territory). Pooled analysis with our patients showed a significant neurological improvement and a good outcome in 13 (68.4%) patients without hemorrhage or any other complication, 6 (31.6%) patients with unfavorable outcome (severe disability 2; vegetative state 4, non of them are died 0;). Conclusion STA-MCA bypass may be beneficial to patients with acute stroke or stenosis in progress who are ineligible for medical therapy. Furthermore, it appears safe when the infarction is small. These findings indicate that STA-MCA bypass could be considered as a treatment option in selected patients with ischemic stroke caused by intracranial stenosis or occlusion.

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Surgical feed ligation performed in 22 year old female with scalp arteriovenous malformation

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192608 ◽

2019 ◽

Vol 7 (7) ◽

pp. 2829

Author(s):

Nyoman Gde Trizka Santhiadi ◽

I. Nyoman Semadi

Keyword(s):

Arteriovenous Malformation ◽

Superficial Temporal Artery ◽

Vascular Anatomy ◽

Major Complication ◽

Surgical Excision ◽

Temporal Artery ◽

Endovascular Embolization ◽

Pulsatile Mass ◽

History Of ◽

Feeding Vessel

Scalp arteriovenous malformation (AVM) are rare conditions that usually need surgical treatment. Its management is difficult because of its high shunt flow, complex vascular anatomy, and possible cosmetic complication. The etiology of scalp AVM may be spontaneous or traumatic. This vascular lesion present as scalp lump or a mass, grotesque, pulsatile mass with a propensity to massive haemorrhage. Various treatment option that have been adopted to treat these lesions include surgical excision, ligation of feeding vessel, trans arterial and transvenous embolization, injection of sclerosant into the nidus and electro thrombosis. A 22-years-old-female referred to cardiothoracic division with a 10 years history of a large fronto-parietal pulsatile reddish soft mass, progressively increasing in size, measuring about 15x6x2 cm, ulcerated area; without any symptoms and history of trauma. Three-dimensional CT angiography demonstrated a mass that was completely within the scalp and prominent vascular that was completely within the scalp and was not associated with bone or periosteum. The feeding arteries were originated from angular artery, supratrochlear artery, left and right superficial temporal artery. Surgical excision and ligation of feeding vessel was performed without complication. With pre-operative appropriate surgical planning, scalp AVM can be excised safely without any major complication. Though some cases may be treated with percutaneous or endovascular embolization, surgery remains the treatment of choice. In the event of scalp ulceration and haemorrhage, total excision is the only option.

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Traumatic arteriovenous fistula of the superficial temporal artery

Jornal Vascular Brasileiro ◽

10.1590/jvb.2014.008 ◽

2014 ◽

Vol 13 (1) ◽

pp. 39-42 ◽

Cited By ~ 1

Author(s):

Otacílio de Camargo Júnior ◽

Márcia Fayad Marcondes de Abreu ◽

Guilherme Camargo Gonçalves de Abreu ◽

Sthefano Atique Gabriel ◽

Isabella Maria Machado da Silva

Keyword(s):

Arteriovenous Fistula ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Surgical Removal ◽

Conventional Surgery ◽

Arteriovenous Fistulae ◽

Motorcycle Accident ◽

Pulsatile Mass ◽

Endovascular Methods ◽

The Right

Arteriovenous fistulae of the superficial temporal artery are rare, and their principal cause is traumas. Complications include pulsatile mass, headache, hemorrhage and deformities that compromise esthetics. Treatment can be performed using conventional surgery or endovascular methods. The authors describe a case of a 44-year-old male patient who developed a large pulsating mass, extending from the preauricular region to the right parietotemporal and frontal regions after a motorcycle accident. The treatment chosen was complete surgical removal of the pulsatile mass and ligature of the vessels feeding the fistula.

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Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass for Nonmoyamoya Steno-Occlusive Disease in Patients Who Failed Optimal Medical Treatment: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opaa458 ◽

2021 ◽

Author(s):

Joseph Haynes ◽

Annick Kronenburg ◽

Eytan Raz ◽

Sara Rostanski ◽

Shadi Yaghi ◽

...

Keyword(s):

Endovascular Treatment ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Superficial Temporal Artery ◽

Case Series ◽

Temporal Artery ◽

Occlusive Disease ◽

Small Series ◽

Recurrent Strokes ◽

Distal Perfusion

Abstract BACKGROUND In the post-Carotid Occlusion Surgery Study (COSS) era, multiple reviews suggested subset groups of patients as potential candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Among them are patients with recurrent strokes despite optimal medical therapy. There is a paucity of data on the outcome of bypass in these specific patients. OBJECTIVE To examine the safety and efficacy of direct STA-MCA bypass in patients with nonmoyamoya, symptomatic steno-occlusive disease with impaired distal perfusion, who failed optimal medical management or endovascular treatment. METHODS A retrospective review was performed to identify patients with cerebrovascular steno-occlusive disease who underwent bypass after symptomatic recurrent or rapidly progressive strokes, despite optimal conservative or endovascular treatment. RESULTS A total of 8 patients (mean age 60 ± 6 yr) underwent direct or combined direct/indirect STA-MCA bypass between 2016 and 2019. All anastomoses were patent. One bypass carried slow flow. There were no procedure-related permanent deficits. One patient developed seizures which were controlled by medications. A total of 7 out of 8 patients were stable or improved clinically at last follow-up (mean 27.3 ± 13.8 mo) without recurrent strokes. One patient did not recover from their presenting stroke, experienced severe bilateral strokes 4 mo postoperatively, and subsequently expired. Modified Rankin Scale (mRS) improved in 6 patients (75%), remained stable in 1 patient (12.5%), and deteriorated in 1 (12.5%). Good long-term functional outcome was achieved in 5 patients (63%, mRS ≤ 2). CONCLUSION Patients with symptomatic, hypoperfused steno-occlusive disease who fail optimal medical or endovascular treatment may benefit from cerebral revascularization. Direct or combined STA-MCA bypass was safe and provided favorable outcomes in this small series.

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Case Report: SPONTANEOUS (TRUE) ANEURYSM OF THE SUPERFICIAL TEMPORAL ARTERY

Folia Medica Indonesiana ◽

10.20473/fmi.v53i2.6433 ◽

2017 ◽

Vol 53 (2) ◽

pp. 159

Author(s):

Ivan Joalsen ◽

G Sianturi ◽

M Niasari

Keyword(s):

Histopathological Examination ◽

Superficial Temporal Artery ◽

Previous History ◽

Temporal Artery ◽

True Aneurysm ◽

Post Operative Period ◽

Pulsatile Mass ◽

Severe Hemorrhage ◽

History Of ◽

Temporal Side

Spontaneous aneurysms of the superficial temporal artery (STA) are rare. Although STA aneurysms have a relatively benign course, when compared with aneurysms of larger caliber arteries, they may occasionally lead to severe hemorrhage and be associated with a multitude of bothersome symptoms. The objective of this study was to report a case of 72-year old male presented with spontaneous STA aneurysm. A 72 years old male presented with a lump on his right temporal side without any previous history of trauma and there was history of long standing hypertension. The lump had first been noticed 2 years before and it had been gradually increasing in size especially within last 6 months. On physical examination there was a pulsatile mass around 2 cm in diameter just above right ear. There was no thrill and bruit. CT angiography showed findings compatible with a STA aneurysm. The patient underwent proximal and distal ligation of the superficial temporal artery and excision of the aneurysm. Histopathological examination confirmed a true aneurysm of STA. The post operative period was uneventful. In conclusion, spontaneous STA aneurysm was best managed by surgical procedure. It consists of ligation and excision. It is simple, safe, and avoids recurrence.

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An uncommon vascular swelling in a child: post traumatic pseudoaneurysm

International Surgery Journal ◽

10.18203/2349-2902.isj20195136 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4127

Author(s):

Vivek Parameswara Sarma

Keyword(s):

Computed Tomography ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Diagnostic Investigation ◽

Temporal Area ◽

Pulsatile Mass ◽

Traumatic Pseudoaneurysm ◽

Pseudo Aneurysm ◽

Post Traumatic ◽

Slow Growing

Pseudo aneurysms of the superficial temporal artery (STA) are very rare (less than 1% of aneurysms), and usually occur after blunt head injury. It usually presents as a slow growing, pulsatile mass in the temporal area. Other symptoms that may occur are headache, ear pain, facial palsy or haemorrhage. Arteriography is the diagnostic investigation and computed tomography angiography will exclude other conditions such as arteriovenous malformation and fistula and confirm the diagnosis. Surgery with ligation of the proximal and the distal parts of the vessel and resection of the aneurysm is the treatment of choice. We report the case of a 10-year-old child, with a pseudo aneurysm of the STA secondary to trauma, who underwent surgical resection of the lesion with good outcome.

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Superficial temporal artery pseudoaneurysm as cause of refractory headache

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v32i2.1956 ◽

2021 ◽

Vol 32 (2) ◽

pp. 199-202

Author(s):

Joaquim Francisco Cavalcante Neto ◽

Sebastião Carlos de Sousa Oliveira ◽

Mateus Aragão Esmeraldo ◽

Francisco Abdoral Brito Júnior ◽

Paulo Roberto Lacerda Leal ◽

...

Keyword(s):

Late Complication ◽

Superficial Temporal Artery ◽

Rare Condition ◽

Temporal Artery ◽

Magnetic Resonance Imaging Scan ◽

Temporal Region ◽

Artery Pseudoaneurysm ◽

Refractory Headache ◽

Pulsatile Mass ◽

Left Temporal Region

Case presentation: A 36-year-old male presented with moderate, progressive headache, in the left temporal region, irradiating to the ipsilateral frontal region, with several months of evolution, refractory to analgesic medication, including opioids. He reported a closed traumatic brain injury (TBI) 5 years before in a motorcycle collision with an automobile, without a helmet. At the physical examination, it was possible to verify a pulsatile mass measuring 1.5 cm in diameter, with fremitus, in the left temporal region. The magnetic resonance imaging scan presented a round lesion, encapsulated, on the course of the superficial temporal artery (STA). The digital subtraction angiography confirmed the diagnosis of STA pseudoaneurysm. A surgical resection of the aneurysm was performed, leading to the complete resolution of the headache. Discussion: The STA pseudoaneurysm is a rare condition, representing less than 1% of aneurysms, usually presenting as a late complication of TBI. The majority of cases are asymptomatic, although focal symptoms and even bleeding may occur. The presentation with a chronic refractory headache is exceptional. Its treatment is indicated for local symptom resolution, aesthetic purposes, and rupture prevention, done by clipping and resection of the pseudoaneurysm. Conclusion: Even though unusual, the awareness of this condition is important for the etiological diagnosis of a persistent temporal headache in a patient with a history of TBI.

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Aneurysmen der distalen Arteria carotis externa

VASA ◽

10.1024/0301-1526.29.1.87 ◽

2000 ◽

Vol 29 (1) ◽

pp. 87-88 ◽

Cited By ~ 2

Author(s):

Vassilios G. Papavassiliou ◽

Liapis ◽

Kakissis ◽

Safioleas ◽

Kaperonis ◽

...

Keyword(s):

Carotid Artery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

External Carotid Artery ◽

External Carotid ◽

Traumatic Aneurysm ◽

First Case ◽

Pulsatile Mass ◽

Posterior Auricular Artery ◽

The Right

Aneurysms of the distal branches of the external carotid artery are rare and usually traumatic in origin. We present two cases which were treated in our clinic. The first case is about a traumatic aneurysm of the left superficial temporal artery (STA) in a young boy 8 years old. The young patient developed a pulsatile mass above his left eyebrow ten days after a bite by a boy of the same age. The second case is referred in a 36-year old woman with a pulsatile mass behind the right ear, which was an aneurysm of the posterior auricular artery. The treatment was ligation and resection under local anesthesia in the first case and under general anesthesia in the latter. Surgeons’ familiarity with this entity is important for diagnosis and treatment.

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Traumatic pseudoaneurysms of the superficial temporal artery: Case series, anatomy, and multidisciplinary treatment considerations

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2014.02.004 ◽

2014 ◽

Vol 21 (9) ◽

pp. 1529-1532 ◽

Cited By ~ 17

Author(s):

Christopher J. Stapleton ◽

Matthew R. Fusco ◽

Ajith J. Thomas ◽

Elad I. Levy ◽

Christopher S. Ogilvy

Keyword(s):

Multidisciplinary Treatment ◽

Superficial Temporal Artery ◽

Case Series ◽

Temporal Artery ◽

Treatment Considerations

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Pseudoaneurysm of the Superficial Temporal Artery After Intracranial Pressure Monitoring Device Placement: Case Report of a Rare Complication

Operative Neurosurgery ◽

10.1093/ons/opaa151 ◽

2020 ◽

Vol 19 (3) ◽

pp. 288-291

Author(s):

James Pan ◽

Guilherme Barros ◽

Madeline E Greil ◽

R Michael Meyer ◽

Chibawanye I Ene ◽

...

Keyword(s):

Intracranial Pressure ◽

Surgical Resection ◽

Rare Complication ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Pressure Monitor ◽

Wound Breakdown ◽

Pulsatile Mass ◽

Device Placement ◽

Long Course

Abstract BACKGROUND AND IMPORTANCE Pseudoaneurysms involving the superficial temporal artery (STA), either iatrogenic or caused by direct trauma, are rare. The STA is prone to injury due to its long course throughout the scalp. Injuries can cause cosmetic defects and/or skin breakdown leading to further complications. CLINICAL PRESENTATION We report a case of delayed iatrogenic pseudoaneurysm of the STA after placement of an intracranial pressure monitor in the setting of acute traumatic brain injury. The patient had a delayed development of a pulsatile mass over his right frontal region, with computed tomography angiography concerning for a pseudoaneurysm of the STA. This was managed with surgical resection with complete resolution of symptoms at follow-up. CONCLUSION We review the literature regarding the etiology, pathogenesis, and management of these lesions. While iatrogenic injuries to the STA have been previously reported, this is a curious case related to placement of an intracranial pressure monitor. We recommend direct surgical resection of the pseudoaneurysm for cosmetic effect and prevention of further wound breakdown.

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