Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 7728  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (839 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

  In this Article
 »  References
 »  Article Figures

 Article Access Statistics
    PDF Downloaded35    
    Comments [Add]    
    Cited by others 6    

Recommend this journal


Table of Contents    
Year : 2013  |  Volume : 61  |  Issue : 6  |  Page : 698-699

Ruptured pseudoaneurysm of the superficial temporal artery after craniotomy

1 Department of Neurosurgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu, Yamaguchi 744-0033, Japan
2 Department of Pathology, Tokuyama Medical Association Hospital, 6-28 Higashiyama, Shunan, Yamaguchi 745-8510, Japan

Date of Submission07-Nov-2013
Date of Decision20-Nov-2013
Date of Acceptance21-Dec-2013
Date of Web Publication20-Jan-2014

Correspondence Address:
Masaru Honda
Department of Neurosurgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu, Yamaguchi 744-0033
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.125406

Rights and Permissions

How to cite this article:
Honda M, Anda T, Ishihara T. Ruptured pseudoaneurysm of the superficial temporal artery after craniotomy. Neurol India 2013;61:698-9

How to cite this URL:
Honda M, Anda T, Ishihara T. Ruptured pseudoaneurysm of the superficial temporal artery after craniotomy. Neurol India [serial online] 2013 [cited 2023 Sep 23];61:698-9. Available from:


Pseudoaneurysm of the superficial temporal artery (STA) after craniotomy is extremely rare [1],[2],[3],[4],[5],[6],[7],[8] and they seldom rupture. [2]

A 57-year-old man was brought with sudden onset loss of consciousness. Computed tomography (CT) revealed subarachnoid hemorrhage and CT-angiography confirmed distal anterior cerebral artery aneurysm at the right A2-A3 junction. Emergency clipping was successfully performed. Patient was given prophylactic triple-H therapy to prevent vasospasm. CT done on the following day revealed a right temporal subcutaneous mass (3 cm diameter 0 at the inferior end of skin incision. The lesion was non-pulsatile with no bruits or thrills and was managed conservatively. On postoperative day-10 there was sudden profuse hemorrhage (1800 ml, estimated) through the sutured skin incision and the patient went into hemorrhagic shock. Three-dimensional CT-angiography confirmed the subcutaneous mass as a partially thrombosed giant aneurysm at the frontal branch of the right STA [Figure 1]a and b. Surgical excision of the aneurysm and evacuation of acute subcutaneous hematoma was performed [Figure 2]a and b. Histological diagnosis was pseudoaneurysm [Figure 2]c and d. The post-operative course was uneventful.
Figure 1: (a) Source image of 3-dimensional computed tomography (CT) showing a partially thrombosed aneurysm.(b) Three-dimensional CT angiography revealing a giant aneurysm originating from the frontal branch of the superficial temporal artery

Click here to view
Figure 2: (a) Disrupted sutured-skin incision in the center of the photo as a crevasse. An aneurysm is located under the discolored skin to the right of this crevasse (arrow). (b and c) Intraoperative photograph showing giant pseudoaneurysm at the anterior branch of the superficial temporal artery (captured by two silk strings). (d) Histologically, the pseudoaneurysm wall consisted of fibroblasts and connective tissue without elastic or smooth muscle tissues (H and E, ×40). Bar indicates 10 μm

Click here to view

Recently there has been reports of STA pseudoaneurysms and literature. [3],[6] in most reported cases the lesions were pulsatile and expanding and non-presented with bleeding [1],[2] and in none the bleeding was life-threatening disrupting an already sutured skin incision. The most plausible cause for formation of pseudoaneurysm is trauma to the STA by skin incision, a pin head-holder, thread removal and subcutaneous drains. [1],[2],[3],[4],[5],[6],[7],[8] In the present case, we believe a needle injury to the frontal branch during subcutaneous closure resulting in slow bleeding and and pseudoaneurysm formation. Terterov and colleagues have suggested that triple-H therapy might accelerate the formation of pseudoaneurysm. [6] Our patient was also given triple-H therapy. A pre-existing arterial wall abnormality might be another contributing factor. [3],[5],[6] Differential diagnoses for STA pseudoaneurysm include vascular tumor, arteriovenous fistula, meningeal artery aneurysm with bony erosion, subcutaneous lipoma, abscess and localized hematoma. [4],[5] In this case, partial thrombosis might be responsible for absence of pulsations or bruit and also headache. [8] Only one patient with bleeding from an STA pseudoaneurysm has been reported, occurring after craniotomy. [2] In that patient, the aneurysm was at the outside of a skin flap, thus preventing subcutaneous hemorrhage. The reported interval between craniotomy and aneurysm formation varied between 4 days and 3 months. [3],[6] Post-operative acute subcutaneous hematoma formation may indicate pseudoaneurysm formation as in this patient. [2] Surgical excision is the most optimal treatment. [2],[3],[4],[7],[8] During hematoma evacuation, we paid close attention to preventing anesthesia-induced hypotension and hence that there is no risk of worsening of symptomatic vasospasm. In addition to surgical excision, catheter embolization has been successfully performed. [5],[6] Percutaneous thrombin injection has also been performed with caution, but remains controversial. [1] In this patient, our decision to manage the swelling conservatively might not have been the correct decision. An aggressive approach would have prevented the life-threatening hemorrhage. We caution the surgeons dealing with this rare entity should anticipate such a complication. To the best of our knowledge, this case is probably the first report of pseudoaneurysm rupture with massive hemorrhage from a sutured skin incision.

 » References Top

1.Bobinski L, Boström S, Hillman J, Theodorsson A. Postoperative pseudoaneurysm of the superficial temporal artery (S.T.A.) treated with Thrombostat (thrombin glue) injection. Acta Neurochir (Wien) 2004;146:1039-41.  Back to cited text no. 1
2.Fernández-Portales I, Cabezudo JM, Lorenzana L, Gómez L, Porras L, Rodríguez JA. Traumatic aneurysm of the superficial temporal artery as a complication of pin-type head-holder device. Case report. Surg Neurol 1999;52:400-3.  Back to cited text no. 2
3.Hakan T, Ersahin M, Somay H, Aker F. Pseudoaneurysm of the superficial temporal artery following revision of a middle cerebral artery aneurysm clipping: Case report and review of the literature. Turk Neurosurg 2011;21:430-4.  Back to cited text no. 3
4.Manzon S, Nguyen T, Philbert R. Bilateral pseudoaneurysms of the superficial temporal artery following reconstruction of the frontal sinus: A case report. J Oral Maxillofac Surg 2007;65:1375-7.  Back to cited text no. 4
5.Shimoda M, Ikeda A, Sato O, Watabe T. A case of multiple superficial temporal artery pseudoaneurysms following craniotomy. No Shinkei Geka 1988;16:797-800.  Back to cited text no. 5
6.Terterov S, McLaughlin N, Martin NA. Postcraniotomy superficial temporal artery pseudoaneurysm in the setting of triple H therapy: A case report and literature review. Surg Neurol Int 2012;3:139.  Back to cited text no. 6
  Medknow Journal  
7.Tsutsumi M, Kawano T, Kawaguchi T, Kaneko Y, Ooigawa H. Pseudoaneurysm of the superficial temporal artery following craniotomy-Case report. Neurol Med Chir (Tokyo) 2000;40:261-3.  Back to cited text no. 7
8.Wang X, Chen JX, You C. Iatrogenic false aneurysm caused by surgery of a traumatic intracranial false aneurysm. Neurol India 2011;59:753-5.  Back to cited text no. 8
[PUBMED]  Medknow Journal  


  [Figure 1], [Figure 2]

This article has been cited by
1 Ruptured presentation of superficial temporal artery pseudoaneurysm treated with anastomotic repair: Case report
Blessing Ndlovu, Mlamuli Mzamo Mkhaliphi, Keletso Leola, Morena Nthuse Mpanza, John Richard Ouma, Christos Profyris
Trauma Case Reports. 2022; 38: 100615
[Pubmed] | [DOI]
2 A Case of Pseudoaneurysm of the Superficial Temporal Artery Causing a Massive Subcutaneous Hematoma after Craniotomy
Masaki Tatano, Seiya Hayashi, Masatoshi Yunoki, Michiari Umakoshi, Koji Hirashita, Kimihiro Yoshino
Asian Journal of Neurosurgery. 2022;
[Pubmed] | [DOI]
3 A false traumatic aneurysm of the superficial temporal artery: case report and literature review
Fei Xie, Hao Jianqiang, Wang Ting, Seidu A. Richard
International Journal of Surgery: Global Health. 2020; 3(5): e22
[Pubmed] | [DOI]
4 Iatrogenic Pseudoaneurysm at the Deep Temporal Artery after Fronto-temporal Craniotomy Manifesting as Repeated Subcutaneous Hemorrhage -Case Report-
Masahito Katsuki, Miki Fujimura, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga
NMC Case Report Journal. 2020; 7(2): 67
[Pubmed] | [DOI]
5 Superficial Temporal Artery Pseudoaneurysm: A Case Report
Syed Muneeb Younus,Muhammad Imran,Rabia Qazi
Frontiers in Surgery. 2015; 2
[Pubmed] | [DOI]
6 Giant life-threatening external carotid artery pseudoaneurysm due to mandibular condylar fracture
André Luis Ribeiro Ribeiro,Walessa Brasil da Silva,Sérgio Melo Alves-Junior,João de Jesus Viana Pinheiro
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2014;
[Pubmed] | [DOI]


Print this article  Email this article
Online since 20th March '04
Published by Wolters Kluwer - Medknow