N-butyl cyanoacrylate embolization of a traumatic pseudoaneurysm and arteriovenous fistula of the middle meningeal artery

Joshua A Cuoco; Evin L Guilliams; Brendan J Klein; Giovanni R Malaty; Mark R Witcher; John J Entwistle

doi:10.1016/j.radcr.2019.12.009

N-butyl cyanoacrylate embolization of a traumatic pseudoaneurysm and arteriovenous fistula of the middle meningeal artery

Radiol Case Rep. 2020 Jan 20;15(4):321-325. doi: 10.1016/j.radcr.2019.12.009. eCollection 2020 Apr.

Authors

Joshua A Cuoco^{1

2

3

4}, Evin L Guilliams^{1

2

3

4}, Brendan J Klein^{1

2

3

4}, Giovanni R Malaty², Mark R Witcher^{1

2

3}, John J Entwistle^{1

2

3

4}

Affiliations

¹ Carilion Clinic, Section of Neurosurgery, 1906 Belleview Ave, Roanoke, VA 24014, USA.
² Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.
³ Virginia Tech School of Neuroscience, 300 Turner Street NW, Blacksburg, VA 24061, USA.
⁴ Edward Via College of Osteopathic Medicine, 2265 Kraft Dr, Blacksburg, VA, 24060, USA.

Abstract

We report a case of combined traumatic pseudoaneurysm and arteriovenous fistula of the middle meningeal artery, which presented clinically 1 year after initial head trauma. A 39-year-old male presented with seizure activity after a closed head injury from a fall. He was hospitalized for multiple intraparenchymal hemorrhages and ultimately discharged 2 weeks later without neurologic deficits. One year later, he presented with a new right anterior temporal intraparenchymal hemorrhage after a syncopal event. Selective angiography of the right external carotid artery demonstrated a chronic appearing traumatic laceration of the proximal middle meningeal artery with a 6 × 10 mm pseudoaneurysm and a single fistula with venous varix draining into the lateral pterygoid veins. The pseudoaneurysm and arteriovenous fistula were successfully embolized with n-butyl cyanoacrylate.

Keywords: Arteriovenous fistula; CT, computer tomography; CTA, computer tomography angiography; Middle meningeal artery; NBCA, n-butyl cyanoacrylate; Neuroradiology; Pseudoaneurysm; Traumatic aneurysm; n-butyl cyanoacrylate.

Publication types

Case Reports