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LETTER TO EDITOR
Year : 2016  |  Volume : 64  |  Issue : 7  |  Page : 120-121

Management dilemmas of traumatic pseudoaneurysm of superficial temporal artery


Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Date of Web Publication3-Mar-2016

Correspondence Address:
Ashish Kumar
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.178055

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How to cite this article:
Kumar A, Rambarki O, Purohit A. Management dilemmas of traumatic pseudoaneurysm of superficial temporal artery. Neurol India 2016;64, Suppl S1:120-1

How to cite this URL:
Kumar A, Rambarki O, Purohit A. Management dilemmas of traumatic pseudoaneurysm of superficial temporal artery. Neurol India [serial online] 2016 [cited 2017 Sep 20];64, Suppl S1:120-1. Available from: http://www.neurologyindia.com/text.asp?2016/64/7/120/178055


Sir,

Pseudoaneurysm of the superficial temporal artery (STA) is a rare entity. It is seen in 1% of all traumatic aneurysms. Most commonly, it is seen after trauma in which 75% of cases are secondary to blunt injury. It often has a superficial location over the frontal bone. [1] We managed a 50-year-old male patient having intermittent bleeding from a diffuse swelling in the right frontal region of the scalp. He was operated for a right frontal depressed fracture following a road traffic accident 4 months back. Elevation of the depressed fragment was done at another center. The postoperative period was uneventful, and the patient was discharged. After 6 weeks, he developed a globular swelling over the operated region. It gradually increased in size and an open biopsy was performed elsewhere for establishing a diagnosis. Due to the significant intraoperative hemorrhage, the procedure was abandoned, and he was referred to our center with bleeding that was controlled by compressive bandages. His hematological parameters were within normal limits, and he was hemodynamically stable. His computed tomography scan showed the craniectomy defect and the hemorrhagic scalp lesion [Figure 1]. A digital subtraction angiography was performed at our center. During the procedure, there were many episodes of intermittent bleeding from the lesion that could not be controlled with compressive bandages. The procedure was continued, and a pseudoaneurysm of the right STA was identified [Figure 2]. Due to the ongoing hemorrhage, microcoils were deployed to a proximal part of STA to obliterate the flow in the aneurysm [Figure 3]. The patient was stable following the procedure and was discharged subsequently.
Figure 1: Computed tomography of the brain showing a hemorrhagic scalp swelling on the right side. The previously operated skull defect is also seen

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Figure 2: Lateral projection of the digital subtraction angiogram showing a pseudoaneurysm arising from the frontal branch of superficial temporal artery. Active contrast extravasation is also seen during the contrast injection

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Figure 3: Postintervention films showing the coil in situ and obliteration of the aneurysm by proximal vessel occlusion

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STA is a terminal branch of the external carotid artery originating while the latter is passing through the parotid gland. The STA divides into the frontal and parietal branches. The frontal branch of STA lies over the bone and remains highly susceptible to injury during blunt trauma. Traumatic pseudoaneurysms can be classified depending on the duration of presentation following the injury. [2],[3] The acute presentations are usually within the first 3 weeks of trauma; the chronic ones are usually detected very late (>3 months); and, those in between are subacute. The diagnosis of a pseudoaneurysm is usually done by an angiogram. The current choice of management is proximal and distal ligation of the artery with excision of the aneurysmal segment. [4] Acute pseudoaneurysms arising from the STA, even if hemodynamically unstable, can be treated rapidly by a simple ligation or cauterization of the main trunk above the zygoma. [3] This procedure can be done under local anesthesia if the patient cooperates well. However, in today's world of interventional neuroradiology, proximal occlusion by way of coiling of the main trunk is an option, too. We must remain cognizant of the cost of these procedures as the economical status of the patients is of significant relevance. Awareness regarding the existence of these vascular lesions of the scalp may avoid unnecessary needle aspirations and potentially catastrophic biopsies.

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  References Top

1.
Pourdanesh F, Salehian M, Dehghan P, Dehghani N, Dehghani S. Pseudoaneurysm of the superficial temporal artery following penetrating trauma. J Craniofac Surg 2013;24:e334-7.  Back to cited text no. 1
    
2.
Stapleton CJ, Fusco MR, Thomas AJ, Levy EI, Ogilvy CS. Traumatic pseudoaneurysms of the superficial temporal artery: Case series, anatomy, and multidisciplinary treatment considerations. J Clin Neurosci 2014;21:1529-32.  Back to cited text no. 2
    
3.
Kim SW, Jong Kim E, Sung KY, Kim JT, Kim YH. Treatment protocol of traumatic pseudoaneurysm of the superficial temporal artery. J Craniofac Surg 2013;24:295-8.  Back to cited text no. 3
    
4.
Ayling O, Martin A, Roche-Nagle G. Primary repair of a traumatic superficial temporal artery pseudoaneurysm: Case report and literature review. Vasc Endovascular Surg 2014;48:346-8.  Back to cited text no. 4
    


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