• Tomoki Kidani, Tomohiko Ozaki, Shin Nakajima, Yonehiro Kanemura, Nobuyuki Izutsu, Saki Kawamoto, Kowashi Taki, Keijiro Murakami, Naoki Nishizawa, Koji Kobayashi, Yosuke Fujimi, and Toshiyuki Fujinaka.
• Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
• World Neurosurg. 2023 Dec 1; 180: e667e675e667-e675.

ObjectiveTraumatic middle meningeal artery (MMA)-middle meningeal vein (MMV) fistula (MMA-MMV fistula) and MMA pseudoaneurysm are the 2 main MMA-related vascular diseases occurring after blunt head trauma. These are rare but known causes of delayed intracranial hemorrhage. This study investigated predictors that may aid in the diagnosis of these diseases.MethodsIn our department, screening digital subtraction angiography (DSA) is performed for patients with blunt head trauma accompanied by intracranial hemorrhage and skull or facial bone fracture. This study included 87 patients who underwent screening DSA without craniotomy from January 2019 to June 2023. The patients' clinical characteristics were retrospectively collected from the database. Statistical analysis was performed to examine the associations of various evaluation items with MMA-related vascular diseases.ResultsThe first DSA examination revealed 34 MMA-MMV fistulas and 1 MMA pseudoaneurysm. The second follow-up DSA examination revealed 13 MMA-MMV fistulas and four MMA pseudoaneurysms. Temporal/parietal bone fracture (odds ratio, 5.33; P = 0.0005; 95% confidence interval, 1.95-14.60) was significantly associated with MMA-related vascular diseases. Endovascular treatments were performed in 9 patients. All procedures were successfully completed without complications; no delayed bleeding was observed.ConclusionsTemporal/parietal bone fracture in patients with blunt head trauma is a likely predictor of MMA-related vascular diseases. When initial head computed tomography reveals this pathology, we recommend careful imaging follow-up (e.g., DSA) and treatment as needed, while considering the possibility of MMA-related vascular diseases.Copyright © 2023 Elsevier Inc. All rights reserved.

25 keywords...

hide…