Abstract
A 47-year-old female presents with a pulsatile left temporal mass, which has been slowly enlarging over the past 3 years. She sustained blunt head trauma 10 years prior from a motor vehicle collision with no subsequent reported injury. Her presenting symptoms include headache, constant audible pulsation, and paresthesias over the left temporal region. Magnetic resonance angiography and computed tomography confirmed the presence of a 5.5 cm (length) 2.3 cm (diameter) proximal superficial temporal artery aneurysm (STA) with feeding branches from the middle temporal artery (A) and (B, Cover). The operative approach included a longitudinal incision directly overlying the aneurysm extending from the preauricular region to the temporal region. The proximal STA, which was nonaneurysmal, was dissected and ligated that rendered the aneurysm nonpulsatile (C). The aneurysm was exposed and dissected along its posterior aspect to avoid injury to the temporal branches of the facial nerve, which traverse anteriorly. The additional feeding branches were ligated, and the entire aneurysm was excised. The patient demonstrated no focal deficits on postoperative cranial nerve examination and remained stable in long-term follow-up. Aneurysms of the superficial temporal are rare and are usually degenerative because of blunt or penetrating trauma to the preauricular or temporal region. True aneurysms of the STA have also been described in isolated case reports. The anterior branch of the STA is most frequently affected. Symptoms may include headache, constant pulsatility, visual disturbances, dizziness, ear discomfort, and hemorrhage. Compression of the proximal superficial temporal artery in the preauricular region frequently diminishes pulsatility and flow. Treatment of choice is ligation of the STA and feeding branches with aneurysm excision. For aneurysms of the proximal STA, temporal branches of the facial nerve are present anteriorly and may cause facial hemiparesis if injured. Although not used in this patient, intraoperative facial nerve monitoring may help avoid iatrogenic injury.
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