Management of Unruptured Traumatic Middle Meningeal Artery Pseudoaneurysms through Onyx Embolization

Abstract

Traumatic pseudoaneurysms of the middle meningeal artery (MMA) represent less than 1% of all intracranial aneurysms, and occur mostly in association with temporal bone fractures following head trauma. Given the unknown natural history, it is unclear whether they should be treated. We present two cases of MMA pseudoaneurysms discovered during trauma workups. The first patient is a 44-year-old male with severe traumatic brain injury (TBI) following a motor vehicle accident. The patient was found to have two right-sided middle meningeal artery pseudoaneurysms that were treated successfully with Onyx® (Medtronic, Minneapolis, MN) embolization. The second patient is a 56-year-old male that sustained a severe TBI and skull fracture following a motorcycle collision. Angiography demonstrated an unruptured right MMA aneurysm, which was also treated successfully with Onyx embolization. MMA pseudoaneurysms occur rarely in the setting of severe traumatic injuries. In select patients, treatment by an experienced neuro-interventionalist can prevent highly morbid future intracranial hemorrhages with minimal risk of complications.

Coil embolization for post-bypass aneurysm of middle meningeal artery for moyamoya disease – preservation of transdural anastomosis

“…In the previous reports on traumatic MMA pseudoaneurysms, aneurysm embolization with parent artery occlusion using a platinum coil or Onyx has been performed. [1,8,11] In our case, intra-aneurysmal embolization was performed without parent artery occlusion to preserve transdural anastomosis. In these methods, the most important issue is aneurysm recurrence.…”