Middle Meningeal Artery Aneurysm: Non-traumatic Incidental Aneurysm of a Middle Meningeal Artery Supplying a Pial Arteriovenous Malformation; Endovascular Occlusion of the Aneurysm Using nBCA During the Preoperative Embolization of the AVM
A 48-year-old male patient presented with a single generalized epileptic seizure and a history of migraine with a left superior quadrantanopia. Diagnostic imaging revealed a large brain arteriovenous malformation (AVM) of the right occipital lobe. A treatment concept of preoperative embolization followed by microsurgical excision was offered to and accepted by the patient. During the first endovascular treatment session, an incidental aneurysm of the right middle meningeal artery (MMA) was found. The right MMA was supplying the pial AVM. Both the right MMA and the aneurysm were occluded by the injection of n-butyl cyanoacrylate diluted with Lipiodol. After a total of 16 embolization sessions, the large AVM was sufficiently devascularized to allow for a microsurgical excision of the AVM, 27 months after the first embolization. Both the endovascular and the microsurgical treatment were carried out without any issues and the complete interruption of the AV-shunt was confirmed by angiography. Occurrence and management of non-traumatic MMA aneurysms is the main topic of this chapter.
KeywordsMiddle meningeal artery Arteriovenous malformation dAVF Preoperative embolization nBCA
- Hedjoudje A, Curado A, Tonnelet D, Gerardin E, Clavier E, Papagiannaki C. Middle meningeal artery aneurysm associated with diffuse calvarial metastases: a case report and review of the literature. J Neuroradiol. 2017;44(5):347–50. https://doi.org/10.1016/j.neurad.2017.06.007.CrossRefPubMedGoogle Scholar