Management of Pseudoaneurysm of Internal Maxillary Artery Resulting from Trauma

Chakrabarty, Sekhar; Majumdar, Swapan Kr.; Ghatak, Abhijit; Bansal, Ankush

doi:10.1007/s12663-012-0427-x

Cited by 17 publications

(32 citation statements)

References 15 publications

(19 reference statements)

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“…In fact, pseudoaneurysms of the OA, STA, and internal maxillary artery could occur more commonly in delayed fashion after indirect impacts including blunt head injuries rather than iatrogenesis. [12][13][14][15] Therefore, it could be important to peel off the periosteum from the cranium gently not to affect the temporal muscle layer directly while flipping the skin flap. We also recommend thorough coagulation of the arterial bleeding and the use of hooked retractor with blunt tip during craniotomy.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Pseudoaneurysm at the Deep Temporal Artery after Fronto-temporal Craniotomy Manifesting as Repeated Subcutaneous Hemorrhage -Case Report-

Katsuki

Fujimura

Sato

et al. 2020

NMC Case Report Journal

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Iatrogenic pseudoaneurysm formation at the deep temporal artery (DTA) is a rare complication after neurosurgical intervention by craniotomy, and its management strategy has yet to be determined. We report a patient who developed iatrogenic pseudoaneurysm at the DTA after fronto-temporal craniotomy manifesting as repeated subcutaneous hemorrhage. A 44-year-old man underwent standard fronto-temporal craniotomy for the microsurgical clipping of a ruptured anterior communicating artery aneurysm in the acute stage. The initial postoperative course was uneventful, but he developed a massive subcutaneous hematoma that penetrated the surgical wound, leading to hypovolemic shock 23 days after the aneurysm surgery. Due to the continuous hemorrhage after temporary hemostasis by ligation of the superficial temporal artery, he underwent catheter angiography, which revealed a newly-formed pseudoaneurysm at the DTA that was 16 mm in diameter. Neuroendovascular obliteration of the pseudoaneurysm was successfully performed using liquid embolization material, n-butyl-2-cyanoacrylate, under local anesthesia. Pseudoaneurysm at the DTA is a rare but possible complication after fronto-temporal craniotomy, which can be fatal due to marked hemorrhage. Due to the anatomically deep location of the DTA under the temporal muscle, we recommend accurate diagnosis of the pseudoaneurysm by catheter angiography and prompt obliteration of the affected vessel by a neuroendovascular procedure under local anesthesia, especially when the hemodynamic status is unstable.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Pseudoaneurysm at the Deep Temporal Artery after Fronto-temporal Craniotomy Manifesting as Repeated Subcutaneous Hemorrhage -Case Report-

Katsuki

Fujimura

Sato

et al. 2020

NMC Case Report Journal

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“…Like all procedures, it does have certain disadvantages, as it requires skilled and experienced interventional radiologists. 12 The incidence of embolization-related complications is much greater than those related to surgical treatment and include necrosis, infection, and detachment of the embolus into the blood flow. 5 The various collaterals between branches from external and internal carotid artery may result in embolus being propelled into branches of internal carotid artery with dangerous sequelae.…”

Section: Treatmentmentioning

confidence: 99%

“…13 Brisk hemorrhage after puncture of the pseudoaneurysm wall or incomplete occlusion after coil embolization may occur during transcatherization. 12 Nevertheless, the great advantage of embolization is the occlusion of the proximal and distal vessels to the injury. The more distal the catheter placement, the safer and more effective the embolization but, unfortunately, the greater the chances of vasospasm being induced.…”

Section: Treatmentmentioning

confidence: 99%

“…13 In the face, 5 the large number of anastomoses often maintain blood flow beyond the zone of injury and embolization. Endovascular technique thus can improve the access to surgically inaccessible vessels and reduces the need for general anesthesia 5,12 and the primary treatment modality in many centers. 12…”

Section: Treatmentmentioning

confidence: 99%

“…Endovascular technique thus can improve the access to surgically inaccessible vessels and reduces the need for general anesthesia 5,12 and the primary treatment modality in many centers. 12…”

Section: Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Lingual Artery Pseudoaneurysm after Severe Facial Trauma

Margallo

Zárate

Franco

et al. 2018

Craniomaxillofacial Trauma & Reconstruction

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The mortality associated with high-energy trauma has several time peaks and variable prognosis. In the particular case of isolated head and neck trauma, management initially includes stabilizing the patient, especially the airway and circulation, and then proceeding to treat injured structures with debridement and often fracture fixation and coverage. We present a case of a male patient who suffered a severe facial trauma at his workplace. He underwent an initial uneventful emergency surgery for control of bleeding and mandibular osteosynthesis. At 2 weeks postoperatively, a second emergency surgery was required to treat a previously undiagnosed lingual pseudoaneurysm that ruptured spontaneously, with massive oral bleeding. The case highlights the clinical significance and timing of pseudoaneurysm formation, and the surveillance and high index of suspicion required for potentially life-threatening bleeding at later time peaks. Diagnostic and therapeutic angiography effectively treated the late complication. Multidisciplinary management options are reviewed, emphasizing the need for rapid decision making and collaboration to improve outcomes in such significant surgical trauma patients.

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